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The clinical value of minimal invasive autopsy in COVID-19 patients

BACKGROUND: 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 ass...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7657516/
https://www.ncbi.nlm.nih.gov/pubmed/33175911
http://dx.doi.org/10.1371/journal.pone.0242300
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author 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
author_facet 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
author_sort D’Onofrio, Valentino
collection PubMed
description BACKGROUND: 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. METHODS AND FINDINGS: 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. CONCLUSION: 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. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT04366882
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spelling pubmed-76575162020-11-18 The clinical value of minimal invasive autopsy in COVID-19 patients 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 PLoS One Research Article BACKGROUND: 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. METHODS AND FINDINGS: 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. CONCLUSION: 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. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT04366882 Public Library of Science 2020-11-11 /pmc/articles/PMC7657516/ /pubmed/33175911 http://dx.doi.org/10.1371/journal.pone.0242300 Text en © 2020 D’Onofrio et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
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
The clinical value of minimal invasive autopsy in COVID-19 patients
title The clinical value of minimal invasive autopsy in COVID-19 patients
title_full The clinical value of minimal invasive autopsy in COVID-19 patients
title_fullStr The clinical value of minimal invasive autopsy in COVID-19 patients
title_full_unstemmed The clinical value of minimal invasive autopsy in COVID-19 patients
title_short The clinical value of minimal invasive autopsy in COVID-19 patients
title_sort clinical value of minimal invasive autopsy in covid-19 patients
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7657516/
https://www.ncbi.nlm.nih.gov/pubmed/33175911
http://dx.doi.org/10.1371/journal.pone.0242300
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