Lung damage in SARS-CoV-2 patients: An autopsy study in the era of vaccination

Rossana Bussani; Aldostefano Porcari; Maurizio Pinamonti; Anthea Iacobucci; Eleonora Belladonna; Ariella Tomasini; Fabrizio Zanconati; Chiara Collesi; Mauro Giacca; Giorgio Berlot; Gianfranco Sinagra; Furio Silvestri

doi:10.1111/eci.14325

Lung damage in SARS-CoV-2 patients: An autopsy study in the era of vaccination

Eur J Clin Invest. 2024 Sep 29:e14325. doi: 10.1111/eci.14325. Online ahead of print.

Authors

Rossana Bussani^{1

2}, Aldostefano Porcari^{3

4}, Maurizio Pinamonti¹, Anthea Iacobucci², Eleonora Belladonna², Ariella Tomasini², Fabrizio Zanconati^{1

2}, Chiara Collesi^{2

5}, Mauro Giacca^{2

5

6}, Giorgio Berlot², Gianfranco Sinagra^{2

3

4}, Furio Silvestri¹

Affiliations

¹ Institute of Pathological Anatomy and Histology, Azienda Sanitaria Universitaria Giuliano-Isontina, University of Trieste, Trieste, Italy.
² Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
³ Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy.
⁴ European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Trieste, Italy.
⁵ International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy.
⁶ School of Cardiovascular Medicine & Sciences, King's College London, British Heart Foundation Centre of Research Excellence, London, UK.

PMID: 39344023
DOI: 10.1111/eci.14325

Abstract

Aims: The contribution of SARS-CoV-2 infection on lung damage and the effect of vaccination on either containing the number of deaths or mitigating lung damage has not been systematically investigated.

Methods: Post-mortem analysis was performed among consecutive in-patients with COVID-19 deceased in the Province of Trieste (2020-2022). The outcomes of the study were (i) rates of in-hospital mortality, (ii) contribution of COVID-19 to death, (iii) histological extent of lung injury and (iv) impact of vaccination.

Results: A total of 1038 consecutive hospitalized patients who died with SARS-CoV-2 infection were autopsied and deep histological analysis of the lungs was performed in a randomly selected sample of 508 cases. Among them, SARS-CoV-2 infection was (a) the cause of death (n = 90), (b) contributing to death (n = 304) and (c) an accompanying feature (n = 114). The incidence of SARS-CoV-2 infection as the primary cause of mortality decreased over time (23.8% in 2020, 20.9% in 2021 and 7.9% in 2022). On multivariable analysis, vaccination (any dose) was independently associated with lower rates of death related to SARS-CoV-2 infection (HR .15, p < .001), after adjusting for other independent predictors. A total of 172 patients were vaccinated at least with two doses at the time of death: 93% triple-vaccinated, 7% double-vaccinated. On histological analysis, vaccinated patients had a greater frequency of pneumonia severity score 0 and 1 (20.3% vs. 5.4% and 20.9% vs. 7.7%, p < .001, respectively), and a substantially lower proportion of pneumonia severity score 3 (26.2% vs. 55.1%, p < .001) compared to unvaccinated patients.

Conclusions: COVID-19 vaccination has substantially reduced rates of death related to SARS-CoV-2 infection over time and may have the ability to mitigate lung damage.

Keywords: COVID‐19; SARS‐CoV‐2; mortality; post‐mortem analysis; vaccination.