1. Pathophysiology of SARS-CoV-2: the Mount Sinai COVID-19 autopsy experience.
- Author
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Bryce C, Grimes Z, Pujadas E, Ahuja S, Beasley MB, Albrecht R, Hernandez T, Stock A, Zhao Z, AlRasheed MR, Chen J, Li L, Wang D, Corben A, Haines GK 3rd, Westra WH, Umphlett M, Gordon RE, Reidy J, Petersen B, Salem F, Fiel MI, El Jamal SM, Tsankova NM, Houldsworth J, Mussa Z, Veremis B, Sordillo E, Gitman MR, Nowak M, Brody R, Harpaz N, Merad M, Gnjatic S, Liu WC, Schotsaert M, Miorin L, Aydillo Gomez TA, Ramos-Lopez I, Garcia-Sastre A, Donnelly R, Seigler P, Keys C, Cameron J, Moultrie I, Washington KL, Treatman J, Sebra R, Jhang J, Firpo A, Lednicky J, Paniz-Mondolfi A, Cordon-Cardo C, and Fowkes ME
- Subjects
- Adult, Aged, Aged, 80 and over, Autopsy, Blood Coagulation, COVID-19 blood, COVID-19 pathology, COVID-19 virology, Cause of Death, Cytokines blood, Female, Host-Pathogen Interactions, Humans, Inflammation Mediators blood, Lung pathology, Lung virology, Male, Middle Aged, New York City, Pulmonary Embolism blood, Pulmonary Embolism pathology, Pulmonary Embolism virology, SARS-CoV-2 pathogenicity, COVID-19 physiopathology, Lung physiopathology, Pulmonary Embolism physiopathology
- Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated clinical syndrome COVID-19 are causing overwhelming morbidity and mortality around the globe and disproportionately affected New York City between March and May 2020. Here, we report on the first 100 COVID-19-positive autopsies performed at the Mount Sinai Hospital in New York City. Autopsies revealed large pulmonary emboli in six cases. Diffuse alveolar damage was present in over 90% of cases. We also report microthrombi in multiple organ systems including the brain, as well as hemophagocytosis. We additionally provide electron microscopic evidence of the presence of the virus in our samples. Laboratory results of our COVID-19 cohort disclose elevated inflammatory markers, abnormal coagulation values, and elevated cytokines IL-6, IL-8, and TNFα. Our autopsy series of COVID-19-positive patients reveals that this disease, often conceptualized as a primarily respiratory viral illness, has widespread effects in the body including hypercoagulability, a hyperinflammatory state, and endothelial dysfunction. Targeting of these multisystemic pathways could lead to new treatment avenues as well as combination therapies against SARS-CoV-2 infection., (© 2021. The Author(s), under exclusive licence to United States & Canadian Academy of Pathology.)
- Published
- 2021
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