by Dr. Juliette Dufour
For January 2022, we have selected: A. Fitzek et al, Prospective postmortem evaluation of 735 consecutive SARS CoV 2 associated death cases. Sci Rep. 2021 Sep 29;11(1):19342. doi: 10.1038/s41598-021-98499-3.
Coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic with significant mortality (about 164 million confirmed cases and over 3.4 million deaths worldwide). Accurate information on the specific circumstances of death and whether patients died from or with SARS-CoV-2 is scarce.
Our authors of the month conducted a systematic review of SARS-CoV-2-associated deaths in Hamburg, Germany, from March to December 2020, using conventional autopsy, ultrasound-guided minimally invasive autopsy, postmortem computed tomography (PMCT) and medical record review. The aim of this systematic postmortem evaluation was to classify all known SARS-CoV-2 associated deaths as COVID-19 or as non-COVID-19 deaths and to compare both groups.
A total of 735 SARS-CoV-2 associated deaths were analysed. Conventional autopsies were performed in 38.5% (n=283), 55.9% (n=411) received a PMCT and 35.9% (n=264) were classified by medical record review only.
84.1% (n= 618) were classified as COVID-19 deaths, 6.4% (n= 47) as non-COVID-19 deaths, and 9.5% (n= 70) remained unclear.
54.4% (n=336) of the COVID-19 death group were men. The median age was 83.0 years (76.0–88.0) with a higher age for women compared to men (median 84 versus 81 years).
Of the 254 COVID-19 deaths in the autopsy group, most patients died of pneumonia and/or diffuse alveolar damage (73.6%; n=187), whereas cardiac associated fatalities were strongly represented in the non-COVID-19 group (70.4%, n=19). Thromboses were found in 39.2% (n= 62/158 cases), pulmonary embolism in 22.1% (n= 56/253 cases). There were 89% (n=226) cardiovascular comorbidities, median BMI was 24.7 kg/m2 and 21.1% (n=43) of the deceased were obese with no significant difference compared to non-COVID-19 deaths.
In 2020, annual mortality in Hamburg was about 5.5% higher than in the previous 20 years, of which 3.4% (n= 618) represented COVID-19 deaths.
The authors of our paper of the month highlight the need for mortality surveillance and postmortem examinations in the context of the worldwide pandemic. They show that the vast majority of deaths associated with SARS-CoV-2 positivity were directly due to COVID-19 (84.1%). Most of the COVID-19 deaths were male with an advanced age and multiple comorbidities, confirming that age, gender and comorbidities are risk factors for fatal outcome.