Original ArticlesPostmortem Findings Associated With SARS-CoV-2 Systematic Review and Meta-analysisSatturwar, Swati MD*; Fowkes, Mary MD, PhD†; Farver, Carol MD‡; Wilson, Allecia M. MD‡; Eccher, Albino MD§; Girolami, Ilaria MD§; Pujadas, Elisabet MD, PhD†; Bryce, Clare MD†; Salem, Fadi MD†; El Jamal, Siraj M. MD†; Paniz-Mondolfi, Alberto MD, PhD†; Petersen, Bruce MD†; Gordon, Ronald E. PhD†; Reidy, Jason MSc†; Fraggetta, Filippo MD∥; Marshall, Desiree A. MD¶; Pantanowitz, Liron MD, MHA‡Author Information *Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA †Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY ‡Department of Pathology, University of Michigan, Ann Arbor, MI §Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona ∥Department of Pathology, Cannizzaro Hospital, Catania, Italy ¶Department of Pathology, University of Washington Medical Center, Seattle, WA Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Correspondence: Liron Pantanowitz, MD, MHA, Department of Pathology, University of Michigan, NCRC Building 35, 2800 Plymouth Road, Ann Arbor, MI 48109-2800 (e-mail: [email protected]). The American Journal of Surgical Pathology: May 2021 - Volume 45 - Issue 5 - p 587-603 doi: 10.1097/PAS.0000000000001650 Buy SDC Metrics Abstract Coronavirus Disease 2019 (COVID-19), caused by the novel Severe Acute Respiratory Syndrome–associated Coronavirus 2 (SARS-CoV-2), has become a global threat to public health. COVID-19 is more pathogenic and infectious than the prior 2002 pandemic caused by SARS-CoV-1. The pathogenesis of certain disease manifestations in COVID-19 such as diffuse alveolar damage (DAD) are thought to be similar to SARS-CoV-1. However, the exact pathogenesis of COVID-19 related deaths remains poorly understood. The aim of this article was to systematically summarize the rapidly emerging literature regarding COVID-19 autopsies. A meta-analysis was also conducted based on data accrued from preprint and published articles on COVID-19 (n=241 patients) and the results compared with postmortem findings associated with SARS-CoV-1 deaths (n=91 patients). Both autopsy groups included mostly adults of median age 70 years with COVID-19 and 50 years with SARS-CoV-1. Overall, prevalence of DAD was more common in SARS-CoV-1 (100.0%) than COVID-19 (80.9%) autopsies (P=0.001). Extrapulmonary findings among both groups were not statistically significant except for hepatic necrosis (P <0.001), splenic necrosis (P<0.006) and white pulp depletion (P <0.001) that were more common with SARS-CoV-1. Remarkable postmortem findings in association with COVID-19 apart from DAD include pulmonary hemorrhage, viral cytopathic effect within pneumocytes, thromboembolism, brain infarction, endotheliitis, acute renal tubular damage, white pulp depletion of the spleen, cardiac myocyte necrosis, megakaryocyte recruitment, and hemophagocytosis. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.