The clinical value of minimal invasive autopsy in COVID-19 patients
Minimally invasive autopsy (MIA) is a validated and safe method to establish the cause of death (COD), mainly in low-resource settings. However, the additional clinical value of MIA in Coronavirus disease (COVID-19) patients in a high-resource setting is unknown. The objective was to assess if and h...
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| Veröffentlicht in: | PloS one 2020-11, Vol.15 (11), p.e0242300-e0242300 |
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| creator | D'Onofrio, Valentino Donders, Elena Vanden Abeele, Marie-Elena Dubois, Jasperina Cartuyvels, Reinoud Achten, Ruth Lammens, Martin Dendooven, Amelie Driessen, Ann Augsburg, Lukasz Vanrusselt, Jan Cox, Janneke |
| description | Minimally invasive autopsy (MIA) is a validated and safe method to establish the cause of death (COD), mainly in low-resource settings. However, the additional clinical value of MIA in Coronavirus disease (COVID-19) patients in a high-resource setting is unknown. The objective was to assess if and how MIA changed clinical COD and contributing diagnoses in deceased COVID-19 patients.
A prospective observational cohort from April to May 2020 in a 981-bed teaching hospital in the epicenter of the COVID-19 pandemic in Belgium was established. Patients who died with either PCR-confirmed or radiologically confirmed COVID-19 infection were consecutively included. MIA consisted of whole-body CT and CT-guided Tru-Cut® biopsies. Diagnostic modalities were clinical chart review, radiology, microbiology, and histopathology which were assessed by two independent experts per modality. MIA COD and contributing diagnoses were established during a multi-disciplinary meeting. Clinical COD (CCOD) and contributing diagnosis were abstracted from the discharge letter. The main outcomes were alterations in CCOD and contributing diagnoses after MIA, and the contribution of each diagnostic modality. We included 18 patients, of which 7 after intensive care unit hospitalization. MIA led to an alteration in 15/18 (83%) patients. The CCOD was altered in 5/18 (28%) patients. MIA found a new COD (1/5), a more specific COD (1/5), a less certain COD (1/5), or a contributing diagnosis to be the COD (2/5). Contributing diagnoses were altered in 14/18 (78%) patients: 9 new diagnoses, 5 diagnoses dismissed, 3 made more specific, and 2 made less certain. Overall, histopathology contributed in 14/15 (93%) patients with alterations, radiology and microbiology each in 6/15 (40%), and clinical review in 3/15 (20%). Histopathology was deemed the most important modality in 10 patients, radiology in two patients, and microbiology in one patient.
MIA, especially histological examination, can add valuable new clinical information regarding the cause of death in COVID-19 patients, even in a high-resource setting with wide access to premortem diagnostic modalities. MIA may provide important clinical insights and should be applied in the current ongoing pandemic.
Clinicaltrials.gov identifier: NCT04366882. |
| doi_str_mv | 10.1371/journal.pone.0242300 |
| format | Article |
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A prospective observational cohort from April to May 2020 in a 981-bed teaching hospital in the epicenter of the COVID-19 pandemic in Belgium was established. Patients who died with either PCR-confirmed or radiologically confirmed COVID-19 infection were consecutively included. MIA consisted of whole-body CT and CT-guided Tru-Cut® biopsies. Diagnostic modalities were clinical chart review, radiology, microbiology, and histopathology which were assessed by two independent experts per modality. MIA COD and contributing diagnoses were established during a multi-disciplinary meeting. Clinical COD (CCOD) and contributing diagnosis were abstracted from the discharge letter. The main outcomes were alterations in CCOD and contributing diagnoses after MIA, and the contribution of each diagnostic modality. We included 18 patients, of which 7 after intensive care unit hospitalization. MIA led to an alteration in 15/18 (83%) patients. The CCOD was altered in 5/18 (28%) patients. MIA found a new COD (1/5), a more specific COD (1/5), a less certain COD (1/5), or a contributing diagnosis to be the COD (2/5). Contributing diagnoses were altered in 14/18 (78%) patients: 9 new diagnoses, 5 diagnoses dismissed, 3 made more specific, and 2 made less certain. Overall, histopathology contributed in 14/15 (93%) patients with alterations, radiology and microbiology each in 6/15 (40%), and clinical review in 3/15 (20%). Histopathology was deemed the most important modality in 10 patients, radiology in two patients, and microbiology in one patient.
MIA, especially histological examination, can add valuable new clinical information regarding the cause of death in COVID-19 patients, even in a high-resource setting with wide access to premortem diagnostic modalities. MIA may provide important clinical insights and should be applied in the current ongoing pandemic.
Clinicaltrials.gov identifier: NCT04366882.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0242300</identifier><identifier>PMID: 33175911</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Aged ; Autopsies ; Autopsy ; Belgium ; Betacoronavirus - genetics ; Betacoronavirus - isolation & purification ; Biology and Life Sciences ; Biopsy ; Cause of Death ; Computed tomography ; Coronavirus Infections - diagnosis ; Coronavirus Infections - diagnostic imaging ; Coronavirus Infections - pathology ; Coronavirus Infections - virology ; Coronaviruses ; COVID-19 ; Diagnosis ; Diagnostic systems ; Disease transmission ; Female ; Heart failure ; Histopathology ; Hospitals ; Humans ; Infectious diseases ; Life sciences ; Male ; Medical diagnosis ; Medical research ; Medicine and Health Sciences ; Methods ; Microbiology ; Pandemics ; Pathology ; Patients ; Pneumonia ; Pneumonia, Viral - diagnosis ; Pneumonia, Viral - diagnostic imaging ; Pneumonia, Viral - pathology ; Pneumonia, Viral - virology ; Prospective Studies ; Radiology ; Research and Analysis Methods ; RNA, Viral - metabolism ; SARS-CoV-2 ; Severe acute respiratory syndrome coronavirus 2 ; Tomography, X-Ray Computed ; Ventilators ; Viral diseases</subject><ispartof>PloS one, 2020-11, Vol.15 (11), p.e0242300-e0242300</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 D’Onofrio et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020 D’Onofrio et al 2020 D’Onofrio et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-13057ec35621bcfea9ad37301a5142582e0727f160992066523458b6a3a7f9d33</citedby><cites>FETCH-LOGICAL-c692t-13057ec35621bcfea9ad37301a5142582e0727f160992066523458b6a3a7f9d33</cites><orcidid>0000-0002-9900-7952 ; 0000-0003-1040-6381</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7657516/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7657516/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33175911$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Pasin, Laura</contributor><creatorcontrib>D'Onofrio, Valentino</creatorcontrib><creatorcontrib>Donders, Elena</creatorcontrib><creatorcontrib>Vanden Abeele, Marie-Elena</creatorcontrib><creatorcontrib>Dubois, Jasperina</creatorcontrib><creatorcontrib>Cartuyvels, Reinoud</creatorcontrib><creatorcontrib>Achten, Ruth</creatorcontrib><creatorcontrib>Lammens, Martin</creatorcontrib><creatorcontrib>Dendooven, Amelie</creatorcontrib><creatorcontrib>Driessen, Ann</creatorcontrib><creatorcontrib>Augsburg, Lukasz</creatorcontrib><creatorcontrib>Vanrusselt, Jan</creatorcontrib><creatorcontrib>Cox, Janneke</creatorcontrib><title>The clinical value of minimal invasive autopsy in COVID-19 patients</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Minimally invasive autopsy (MIA) is a validated and safe method to establish the cause of death (COD), mainly in low-resource settings. However, the additional clinical value of MIA in Coronavirus disease (COVID-19) patients in a high-resource setting is unknown. The objective was to assess if and how MIA changed clinical COD and contributing diagnoses in deceased COVID-19 patients.
A prospective observational cohort from April to May 2020 in a 981-bed teaching hospital in the epicenter of the COVID-19 pandemic in Belgium was established. Patients who died with either PCR-confirmed or radiologically confirmed COVID-19 infection were consecutively included. MIA consisted of whole-body CT and CT-guided Tru-Cut® biopsies. Diagnostic modalities were clinical chart review, radiology, microbiology, and histopathology which were assessed by two independent experts per modality. MIA COD and contributing diagnoses were established during a multi-disciplinary meeting. Clinical COD (CCOD) and contributing diagnosis were abstracted from the discharge letter. The main outcomes were alterations in CCOD and contributing diagnoses after MIA, and the contribution of each diagnostic modality. We included 18 patients, of which 7 after intensive care unit hospitalization. MIA led to an alteration in 15/18 (83%) patients. The CCOD was altered in 5/18 (28%) patients. MIA found a new COD (1/5), a more specific COD (1/5), a less certain COD (1/5), or a contributing diagnosis to be the COD (2/5). Contributing diagnoses were altered in 14/18 (78%) patients: 9 new diagnoses, 5 diagnoses dismissed, 3 made more specific, and 2 made less certain. Overall, histopathology contributed in 14/15 (93%) patients with alterations, radiology and microbiology each in 6/15 (40%), and clinical review in 3/15 (20%). Histopathology was deemed the most important modality in 10 patients, radiology in two patients, and microbiology in one patient.
MIA, especially histological examination, can add valuable new clinical information regarding the cause of death in COVID-19 patients, even in a high-resource setting with wide access to premortem diagnostic modalities. MIA may provide important clinical insights and should be applied in the current ongoing pandemic.
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Academic</collection><collection>ProQuest Engineering Collection</collection><collection>ProQuest Biological Science Collection</collection><collection>Agricultural Science Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Engineering Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Environmental Science Database</collection><collection>Materials Science Collection</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>D'Onofrio, Valentino</au><au>Donders, Elena</au><au>Vanden Abeele, Marie-Elena</au><au>Dubois, Jasperina</au><au>Cartuyvels, Reinoud</au><au>Achten, Ruth</au><au>Lammens, Martin</au><au>Dendooven, Amelie</au><au>Driessen, Ann</au><au>Augsburg, Lukasz</au><au>Vanrusselt, Jan</au><au>Cox, Janneke</au><au>Pasin, Laura</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The clinical value of minimal invasive autopsy in COVID-19 patients</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2020-11-11</date><risdate>2020</risdate><volume>15</volume><issue>11</issue><spage>e0242300</spage><epage>e0242300</epage><pages>e0242300-e0242300</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Minimally invasive autopsy (MIA) is a validated and safe method to establish the cause of death (COD), mainly in low-resource settings. However, the additional clinical value of MIA in Coronavirus disease (COVID-19) patients in a high-resource setting is unknown. The objective was to assess if and how MIA changed clinical COD and contributing diagnoses in deceased COVID-19 patients.
A prospective observational cohort from April to May 2020 in a 981-bed teaching hospital in the epicenter of the COVID-19 pandemic in Belgium was established. Patients who died with either PCR-confirmed or radiologically confirmed COVID-19 infection were consecutively included. MIA consisted of whole-body CT and CT-guided Tru-Cut® biopsies. Diagnostic modalities were clinical chart review, radiology, microbiology, and histopathology which were assessed by two independent experts per modality. MIA COD and contributing diagnoses were established during a multi-disciplinary meeting. Clinical COD (CCOD) and contributing diagnosis were abstracted from the discharge letter. The main outcomes were alterations in CCOD and contributing diagnoses after MIA, and the contribution of each diagnostic modality. We included 18 patients, of which 7 after intensive care unit hospitalization. MIA led to an alteration in 15/18 (83%) patients. The CCOD was altered in 5/18 (28%) patients. MIA found a new COD (1/5), a more specific COD (1/5), a less certain COD (1/5), or a contributing diagnosis to be the COD (2/5). Contributing diagnoses were altered in 14/18 (78%) patients: 9 new diagnoses, 5 diagnoses dismissed, 3 made more specific, and 2 made less certain. Overall, histopathology contributed in 14/15 (93%) patients with alterations, radiology and microbiology each in 6/15 (40%), and clinical review in 3/15 (20%). Histopathology was deemed the most important modality in 10 patients, radiology in two patients, and microbiology in one patient.
MIA, especially histological examination, can add valuable new clinical information regarding the cause of death in COVID-19 patients, even in a high-resource setting with wide access to premortem diagnostic modalities. MIA may provide important clinical insights and should be applied in the current ongoing pandemic.
Clinicaltrials.gov identifier: NCT04366882.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>33175911</pmid><doi>10.1371/journal.pone.0242300</doi><orcidid>https://orcid.org/0000-0002-9900-7952</orcidid><orcidid>https://orcid.org/0000-0003-1040-6381</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2020-11, Vol.15 (11), p.e0242300-e0242300 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2459616403 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Aged Autopsies Autopsy Belgium Betacoronavirus - genetics Betacoronavirus - isolation & purification Biology and Life Sciences Biopsy Cause of Death Computed tomography Coronavirus Infections - diagnosis Coronavirus Infections - diagnostic imaging Coronavirus Infections - pathology Coronavirus Infections - virology Coronaviruses COVID-19 Diagnosis Diagnostic systems Disease transmission Female Heart failure Histopathology Hospitals Humans Infectious diseases Life sciences Male Medical diagnosis Medical research Medicine and Health Sciences Methods Microbiology Pandemics Pathology Patients Pneumonia Pneumonia, Viral - diagnosis Pneumonia, Viral - diagnostic imaging Pneumonia, Viral - pathology Pneumonia, Viral - virology Prospective Studies Radiology Research and Analysis Methods RNA, Viral - metabolism SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 Tomography, X-Ray Computed Ventilators Viral diseases |
| title | The clinical value of minimal invasive autopsy in COVID-19 patients |
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