Background Long-term sequelae of coronavirus disease 2019 (COVID-19), including the interaction between persisting viral-RNA and specific tissue involvement, pose a challenging issue. In this study, we addressed the chronological correlation (after first clinical diagnosis and postmortem) between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA and organ involvement. Methods The presence of postmortem SARS-CoV-2 RNA from 35 complete COVID-19 autopsies was correlated with the time interval between the first diagnosis of COVID-19 and death and with its relationship to morphologic findings. Results Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA can be evident up to 40 days after the first diagnosis and can persist to 94 hours after death. Postmortem SARS-CoV-2 RNA was mostly positive in lungs (70%) and trachea (69%), but all investigated organs were positive with variable frequency. Late-stage tissue damage was evident up to 65 days after initial diagnosis in several organs. Positivity for SARS-CoV-2 RNA in pulmonary swabs correlated with diffuse alveolar damage ( p = 0.0009). No correlation between positive swabs and other morphologic findings was present. Cerebral ( p = 0.0003) and systemic hemorrhages ( p = 0.009), cardiac thrombi ( p = 0.04), and ischemic events ( p = 0.03) were more frequent in the first wave, whereas bacterial pneumonia ( p = 0.03) was more prevalent in the second wave. No differences in biometric data, clinical comorbidities, and other autopsy findings were found. Conclusions Our data provide evidence not only of long-term postmortem persisting SARS-CoV-2 RNA but also of tissue damage several weeks after the first diagnosis of SARS-CoV-2 infection. Additional conditions, such as concomitant bacterial pulmonary superinfection, lung aspergillosis, thromboembolic phenomena, and hemorrhages can further worsen tissue damage.
【저자키워드】 COVID-19, Autopsy, Histopathology, long-COVID, SARS-CoV-2 RNA PCR, postmortal swabs, pulmonary superinfections, 【초록키워드】 coronavirus disease, SARS-CoV-2, coronavirus, Pneumonia, Infection, Comorbidities, Diagnosis, lung, RNA, death, second wave, Diffuse alveolar damage, SARS-CoV-2 RNA, Postmortem, Swab, correlation, Clinical diagnosis, First wave, Bacterial, Evidence, Interaction, Frequency, cerebral, hemorrhage, thromboembolic, acute respiratory syndrome, tissue, tissue damage, organs, positive, positive swab, organ, Complete, event, prevalent, initial, Result, investigated, correlated, conditions, addressed, diagnosis of COVID-19, diagnosis of SARS-CoV-2, 【제목키워드】 SARS-CoV-2 RNA, lesson, pathological, Sery,