Neutrophil Infiltration Induces Myocardial Injury in COVID-19 Post-Mortem Cases
Abstract Background: The pathological features of severe cardiac injury induced by COVID-19 and relevant clinical features is unknown. This post-mortem study intended to determine the pathological findings of hearts from critically ill COVID-19 cases and explore the association of pathological changes and clinical characteristics.Methods: This autopsy cohort study, including hearts from 26 deceased COVID-19 patients admitted in intensive care unit, was conducted at four sites in Wuhan, China. Pathological changes were evaluated using hematoxylin and eosin, and immunohistochemical staining. Cases were divided into neutrophil-infiltration group and no-neutrophil group according to histopathological identification of neutrophilic infiltrates or not. Results: Among 26 cases, four cases had active myocarditis with histopathological examination. All cases with myocarditis accompanied with extensive neutrophil infiltration, while cases without myocarditis did not. Detection rates of interleukin-6 and tumor necrosis factor-α in neutrophil-infiltration group were significantly higher compared to no-neutrophil group. At admission, patients with neutrophil infiltration in myocardium had significantly higher baseline values of aspartate aminotransferase, D dimer and high-sensitivity C reactive protein compared to other 22 patients (P<0.05 for all). During hospitalization, patients with neutrophil infiltration had a significantly higher maximum of creatine kinase (CK)-MB than patients without neutrophil infiltration. Conclusions: In hearts from deceased patients with severe COVID-19, active myocarditis was commonly infiltrated with neutrophils. Cases with neutrophil-infiltrated myocarditis had severe abnormal laboratory tests involving multiple organs at admission, and a high peak value of CK-MB during hospitalization. Role of neutrophil on severe heart injury and even systemic condition in COVID-19 should be emphasized.