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Pathophysiology of SARS-CoV-2: the Mount Sinai COVID-19 autopsy experience.

Clare BryceZachary GrimesElisabet PujadasSadhna AhujaMary Beth BeasleyRandy A AlbrechtTahyna HernandezAryeh StockZhen ZhaoMohamed Rizwan AlRasheedJoyce ChenLi LiDiane WangAdriana CorbenG Kenneth HainesWilliam H WestraMelissa UmphlettRonald E GordonJason ReidyBruce E PetersenFadi SalemMaria Isabel FielSiraj M El JamalNadejda M TsankovaJane HouldsworthZarmeen MussaBrandon VeremisEmilia Mia SordilloMelissa R GitmanMichael NowakRachel BrodyNoam HarpazMiriam MeradSacha GnjaticWen-Chun LiuMichael SchotsaertLisa MiorinTeresa A Aydillo GomezIrene Ramos-LopezAdolfo Garcia-SastreRyan DonnellyPatricia SeiglerCalvin KeysJennifer CameronIsaiah MoultrieKae-Lynn WashingtonJacquelyn TreatmanRobert SebraJeffrey JhangAdolfo FirpoJohn LednickyAlberto Paniz-MondolfiCarlos Cordon-CardoMary E Fowkes
Published in: Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc (2021)
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.
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