Causes of death and comorbidities in hospitalized patients with COVID-19

  1. Sefer Elezkurtaj
  2. Selina Greuel
  3. Jana Ihlow
  4. Edward Georg Michaelis
  5. Philip Bischoff
  6. Catarina Alisa Kunze
  7. Bruno Valentin Sinn
  8. Manuela Gerhold
  9. Kathrin Hauptmann
  10. Barbara Ingold-Heppner
  11. Florian Miller
  12. Hermann Herbst
  13. Victor Max Corman
  14. Hubert Martin
  15. Helena Radbruch
  16. Frank L. Heppner
  17. David Horst

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Abstract

Infection by the new corona virus strain SARS-CoV-2 and its related syndrome COVID-19 has been associated with more than two million deaths worldwide. Patients of higher age and with preexisting chronic health conditions are at an increased risk of fatal disease outcome. However, detailed information on causes of death and the contribution of pre-existing health conditions to death yet is missing, which can be reliably established by autopsy only. We performed full body autopsies on 26 patients that had died after SARS-CoV-2 infection and COVID-19 at the Charité University Hospital Berlin, Germany, or at associated teaching hospitals. We systematically evaluated causes of death and pre-existing health conditions. Additionally, clinical records and death certificates were evaluated. We report findings on causes of death and comorbidities of 26 decedents that had clinically presented with severe COVID-19. We found that septic shock and multi organ failure was the most common immediate cause of death, often due to suppurative pulmonary infection. Respiratory failure due to diffuse alveolar damage presented as immediate cause of death in fewer cases. Several comorbidities, such as hypertension, ischemic heart disease, and obesity were present in the vast majority of patients. Our findings reveal that causes of death were directly related to COVID-19 in the majority of decedents, while they appear not to be an immediate result of preexisting health conditions and comorbidities. We therefore suggest that the majority of patients had died of COVID-19 with only contributory implications of preexisting health conditions to the mechanism of death.

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  1. Version published to 10.1038/s41598-021-82862-5
  2. ScreenIT

    SciScore for 10.1101/2020.06.15.20131540: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: This study was approved by the Ethics Committee of the Charité (EA 1/144/13 and EA2/066/20) as well as by the Charité-BIH COVID-19 research board and was in compliance with the Declaration of Helsinki.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analysis: Data collection and statistical analysis were done with IBM SPSS Statistics, Version 23 (IBM, NY, USA).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    A limitation of our study is the relatively small sample size. Furthermore, patients included in this study had reached a median age of 70 years, which mirrors reported age distributions of inpatient non-survivors in Wuhan12, and data from a recent autopsy report16, but is lower than suggested by other epidemiologic data from Italy on COVID-19 decedents22. While regional factors may influence age distribution, this discrepancy also suggests a case selection bias, and we speculate this may reflect which patients were hospitalized and therefore received most intense therapeutic measures. The interpretation of autopsy results and conclusions on health impacts of COVID-19 therefore requires careful consideration of the study population.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.06.15.20131540v1 on medRxiv