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

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sefer Elezkurtaj ◽  
Selina Greuel ◽  
Jana Ihlow ◽  
Edward Georg Michaelis ◽  
Philip Bischoff ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Causes Of Death ◽  
Pulmonary Infection ◽  
Diffuse Alveolar Damage ◽  
University Hospital ◽  
Health Conditions ◽  
Teaching Hospitals ◽  
Increased Risk ◽  
Clinical Records ◽  
Full Body

AbstractInfection 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.

scholarly journals Causes of Death and Comorbidities in Patients with COVID-19

2020 ◽  
Author(s):  
Sefer Elezkurtaj ◽  
Selina Greuel ◽  
Jana Ihlow ◽  
Edward Michaelis ◽  
Philip Bischoff ◽  
...  
Keyword(s):  
Septic Shock ◽  
Heart Disease ◽  
Cause Of Death ◽  
Causes Of Death ◽  
Pulmonary Infection ◽  
Diffuse Alveolar Damage ◽  
Chronic Health Conditions ◽  
Health Conditions ◽  
Fatal Disease ◽  
Increased Risk

ABSTRACTInfection by the new corona virus strain SARS-CoV-2 and its related syndrome COVID-19 has caused several hundreds of thousands of 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 comorbidities to death yet is missing. Here, we report autopsy 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 the most 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.

scholarly journals Postmortem examination protocol and systematic re-evaluation reduce the proportion of unexplained stillbirths

2020 ◽  
Vol 48 (8) ◽  
pp. 771-777
Author(s):  
Maria Pekkola ◽  
Minna Tikkanen ◽  
Mikko Loukovaara ◽  
Jouko Lohi ◽  
Jorma Paavonen ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Medical Records ◽  
Retrospective Cohort ◽  
Causes Of Death ◽  
Postmortem Examination ◽  
University Hospital ◽  
Obstetrics And Gynecology ◽  
Common Cause ◽  
Examination Protocol

AbstractBackgroundStillbirth often remains unexplained, mostly due to a lack of any postmortem examination or one that is incomplete and misinterpreted.MethodsThis retrospective cohort study was conducted at the Department of Obstetrics and Gynecology, Helsinki University Hospital, Finland, and comprised 214 antepartum singleton stillbirths from 2003 to 2015. Maternal and fetal characteristics and the results of the systematic postmortem examination protocol were collected from medical records. Causes of death were divided into 10 specific categories. Re-evaluation of the postmortem examination results followed.ResultsBased on our systematic protocol, the cause of death was originally defined and reported as such to parents in 133 (62.1%) cases. Re-evaluation of the postmortem examination results revealed the cause of death in an additional 43 (20.1%) cases, with only 23 (10.7%) cases remaining truly unexplained. The most common cause of stillbirth was placental insufficiency in 56 (26.2%) cases. A higher proportion of stillbirths that occurred at ≥39 gestational weeks remained unexplained compared to those that occurred earlier (24.1% vs. 8.6%) (P = 0.02).ConclusionA standardized postmortem examination and a re-evaluation of the results reduced the rate of unexplained stillbirth. Better knowledge of causes of death may have a major impact on the follow-up and outcome of subsequent pregnancies. Also, closer examination and better interpretation of postmortem findings is time-consuming but well worth the effort in order to provide better counseling for the grieving parents.

scholarly journals Study of Clinical-Pathological Discrepancies in Autopsie

2021 ◽  
Vol 6 (2) ◽  
Keyword(s):  
Cause Of Death ◽  
Causes Of Death ◽  
Cross Sectional Study ◽  
Age Group ◽  
Porto Alegre ◽  
Cross Sectional ◽  
Previous Decade ◽  
Clinical Diagnoses ◽  
Epidemiological Profile ◽  
Clinical Records

Background: Autopsy is a traditional method in pathology for the study of diseases or injuries, being key to elucidate the cause of death. However, the number of autopsies has been decreasing progressively. Design and Context: Retrospective cross-sectional study to analyze the presence of discrepancy between clinical and pathological diagnoses as to the cause of death according to the Goldman criteria, verify the epidemiological profile of the main causes of death, and tabulate the number of procedures conducted annually. Method: Analyzing clinical records and autopsy reports from the Department of Pathology and Legal Medicine of the Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) from 1963 to 2012 and performing statistical analysis on the data collected. Results: The predominant age group was of dead fetuses (30.6% of all cases). The main cause of death was infection (68.4% of diagnoses). After a peak in the early 1980s, there was a progressive drop in the rates of postmortem examination. In the 1990s, the average number of autopsies fell by 58% in relation to the previous decade, and the last decade of the Century registered a decrease of 80% as compared to the average of the 1980s. According to the Goldman criteria, there was discrepancy between ante- and postmortem diagnoses as to the cause of death in 26.2% of the cases. Conclusion: The rates of discrepancy between clinical diagnoses and autopsy findings regarding the cause of death remain high, even though medicine has become more and more advanced in technology.

scholarly journals Epilepsy-associated long-term mortality after aneurysmal subarachnoid hemorrhage

Neurology ◽  
2017 ◽  
Vol 89 (3) ◽  
pp. 263-268 ◽  
Author(s):  
Jukka Huttunen ◽  
Antti Lindgren ◽  
Mitja I. Kurki ◽  
Terhi Huttunen ◽  
Juhana Frösen ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Causes Of Death ◽  
University Hospital ◽  
Study Cohort ◽  
Catchment Population ◽  
Risk Of Death ◽  
Increased Risk ◽  
Long Term Mortality

Objective:To elucidate the epilepsy-associated causes of death and subsequent excess long-term mortality among 12-month survivors of subarachnoid hemorrhage from saccular intracranial aneurysm (SIA-SAH).Methods:The Kuopio SIA Database (kuopioneurosurgery.fi) includes all SIA-SAH patients admitted to the Kuopio University Hospital from its defined catchment population in Eastern Finland. The study cohort consists of 779 patients, admitted from 1995 to 2007, who were alive at 12 months after SIA-SAH. Their use of reimbursable antiepileptic drugs and the causes of death (ICD-10) were fused from the Finnish national registries from 1994 to 2014.Results:The 779 12-month survivors were followed up until death (n = 197) or December 31, 2014, a median of 12.0 years after SIA-SAH. Epilepsy had been diagnosed in 121 (15%) patients after SIA-SAH, and 34/121 (28%) had died at the end of follow-up, with epilepsy as the immediate cause of death in 7/34 (21%). In the 779 patients alive at 12 months after SIA-SAH, epilepsy was an independent risk factor for mortality (hazard ratio 1.8, 95% confidence interval 1.1–3.0).Conclusions:Comorbid epilepsy in 12-month survivors of SIA-SAH is associated with increased risk of death in long-term follow-up. Survivors of SIA-SAH require long-term dedicated follow-up, including identification and effective treatment of comorbid epilepsy to prevent avoidable deaths.

Study of Clinical-Pathological Discrepancies in Autopsies

2021 ◽  
Vol 6 (2) ◽  
Keyword(s):  
Cause Of Death ◽  
Causes Of Death ◽  
Cross Sectional Study ◽  
Age Group ◽  
Porto Alegre ◽  
Cross Sectional ◽  
Previous Decade ◽  
Clinical Diagnoses ◽  
Epidemiological Profile ◽  
Clinical Records

Background: Autopsy is a traditional method in pathology for the study of diseases or injuries, being key to elucidate the cause of death. However, the number of autopsies has been decreasing progressively. Design and Context: Retrospective cross-sectional study to analyze the presence of discrepancy between clinical and pathological diagnoses as to the cause of death according to the Goldman criteria, verify the epidemiological profile of the main causes of death, and tabulate the number of procedures conducted annually. Method: Analyzing clinical records and autopsy reports from the Department of Pathology and Legal Medicine of the Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) from 1963 to 2012 and performing statistical analysis on the data collected. Results: The predominant age group was of dead fetuses (30.6% of all cases). The main cause of death was infection (68.4% of diagnoses). After a peak in the early 1980s, there was a progressive drop in the rates of postmortem examination. In the 1990s, the average number of autopsies fell by 58% in relation to the previous decade, and the last decade of the Century registered a decrease of 80% as compared to the average of the 1980s. According to the Goldman criteria, there was discrepancy between ante- and postmortem diagnoses as to the cause of death in 26.2% of the cases. Conclusion: The rates of discrepancy between clinical diagnoses and autopsy findings regarding the cause of death remain high, even though medicine has become more and more advanced in technology.

P4150Causes of death in a heart failure clinic in Spain along 17 years

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Moliner ◽  
J Lupon ◽  
M De Antonio ◽  
M Domingo ◽  
E Santiago-Vacas ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sudden Death ◽  
Cause Of Death ◽  
Causes Of Death ◽  
Linear Increase ◽  
Unexpected Death ◽  
Peripheral Ischemia ◽  
Heart Failure Clinic ◽  
Clinical Records ◽  
Mode Of Death

Abstract Background Advances in heart failure (HF) treatment have achieved a reduction of death in HF patients in the last two decades. Indeed, not only mortality has been reduced but also the mode of death might have been modified through these years. Purpose To assess the causes of death in outpatients attended in a HF Unit since the year 2002 up to the year 2018. Methods Causes of death were classified as follows: progression of HF (worsening HF or treatment-resistant HF, in the absence of another cause); sudden death (any unexpected death, witnessed or not, of a previously stable patient with no evidence of worsening HF or any other known cause of death); acute myocardial infarction; stroke; procedural (post-diagnostic or post-therapeutic); other cardiovascular causes (e.g., rupture of an aneurysm, peripheral ischemia, or aortic dissection), and non-cardiovascular. Patients who died of unknown cause were excluded from the analysis. Fatal events were identified from the clinical records of patients with HF, hospital wards, the emergency room, general practitioners, or by contacting the patient's relatives. Furthermore, data were verified from the databases of the Catalan and Spanish Health Systems. Trends on every cause of death were assessed by linear regression. Results Since August 2001 to May 2018, 2295 HF patients were admitted to the HF clinic (age 66.4±12.8 years, 71% men, 49% from ischemic aetiology, mean LVEF 35.2% ± 14). During the 17 years of the study, 1201 deaths were recorded. Seventy-eight patients (6.5% of deaths) were excluded due to unknown cause of death. The evolution in the mode of death by years is shown in the figure. Two trends were observed: a decrease in sudden death (p=0.05) and a very significant linear increase in non-cardiovascular causes of death (p<0.001). The decrease of sudden death was mainly driven from changes observed in the first 10 years (p=0.014); thereafter the incidence of sudden death remained stable (p=0.18). Remarkably we did not observe significant changes in HF progression as mode of death (p=0.17). Conclusions During the 17 years of the study, a very significant trend towards higher percentage of non-cardiovascular deaths was progressively observed. On the other hand, percentage of sudden death showed a gradual decrease, mainly driven from the changes observed in the first 10 years.

scholarly journals A Importância da Autópsia na Morte Neonatal Precoce em Portugal

2020 ◽  
Vol 33 (12) ◽  
pp. 811
Author(s):  
Marlene Miranda ◽  
Sandra Costa ◽  
Henrique Soares ◽  
Joselina Barbosa ◽  
Filipa Flor-de-Lima ◽  
...  
Keyword(s):  
Genetic Counseling ◽  
Cause Of Death ◽  
Neonatal Death ◽  
Neonatal Intensive Care ◽  
Causes Of Death ◽  
Neonatal Period ◽  
Clinical Importance ◽  
Pathological Findings ◽  
Early Neonatal Death ◽  
Clinical Records

Introduction: The early neonatal period is the most critical for the newborn’s life. The autopsy is important to understand the cause of death, and find other diagnoses not clinically identified. However, the rate of neonatal autopsy is declining worldwide. This study aims to characterize early neonatal death and the clinical importance of the autopsy, evaluating the concordance between clinical and pathological diagnosis.Material and Methods: Retrospective study of the clinical records of all neonates admitted to a level III Neonatal Intensive Care unit in Portugal who died during the first week of life in 10 consecutive years (2008 – 2017). In order to classify the concordance found between clinical and pathological diagnoses, the modified Goldman classification was used.Results: During the first week of life, 76 newborns died. The main causes of death were complications related with prematurity and congenital malformations. The autopsy was performed in 50 newborns. Additional findings were found in 62% of the cases, and in 12% findings with important implications for genetic counseling of future pregnancies. There was concordance between the clinical and pathological findings in 38% of cases.Discussion: An autopsy was performed more frequently in newborns with greater gestational age. The number of additional diagnoses found at autopsy, including diagnoses with implications for genetic counseling, confirm the importance of performing them.Conclusion: An autopsy should be proposed to all parents after early neonatal death, given its importance in clarifying the cause of death.

scholarly journals Cause of death in spontaneous intracerebral hemorrhage survivors

Neurology ◽  
2020 ◽  
Vol 95 (20) ◽  
pp. e2736-e2745
Author(s):  
Lindsey R. Kuohn ◽  
Audrey C. Leasure ◽  
Julian N. Acosta ◽  
Kevin Vanent ◽  
Santosh B. Murthy ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Cause Of Death ◽  
Intracranial Hemorrhage ◽  
Causes Of Death ◽  
Multinomial Logistic Regression ◽  
Hospital Readmissions ◽  
Cox Proportional Hazards ◽  
Term Survival ◽  
Increased Risk

ObjectiveTo determine the leading causes of death in intracerebral hemorrhage (ICH) survivors, we used administrative data from 3 large US states to identify adult survivors of a first-time spontaneous ICH and track all hospital readmissions resulting in death.MethodsWe performed a longitudinal analysis of prospectively collected claims data from hospitalizations in California (2005–2011), New York (2005–2014), and Florida (2005–2014). Adult residents admitted with a nontraumatic ICH who survived to discharge were included. Patients were followed for a primary outcome of any readmission resulting in death. The cause of death was defined as the primary diagnosis assigned at discharge. Multivariable Cox proportional hazards and multinomial logistic regression were used to determine factors associated with the risk for and cause of death.ResultsOf 72,432 ICH survivors (mean age 68 years [SD 16], 48% female), 12,753 (18%) died during a median follow-up period of 4.0 years (interquartile range 2.3–6.3). The leading causes of death were infection (34%), recurrent intracranial hemorrhage (14%), cardiac disease (8%), respiratory failure (8%), and ischemic stroke (5%). Death in patients with atrial fibrillation (AF) was more likely to be caused by ischemic stroke (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.9–2.9, p < 0.001) and less likely to be caused by recurrent intracranial hemorrhage (OR 0.7, 95% CI 0.6–0.8, p < 0.001) compared to patients without AF.ConclusionsInfection is the leading cause of death in all ICH survivors. Survivors with AF were at increased risk for death from ischemic stroke. These findings will help prioritize interventions aimed to improve long-term survival and recovery in ICH survivors.

Causes of Death of Patients With Lung Cancer

2012 ◽  
Vol 136 (12) ◽  
pp. 1552-1557 ◽  
Author(s):  
Larry Nichols ◽  
Rachel Saunders ◽  
Friedrich D. Knollmann
Keyword(s):  
Lung Cancer ◽  
Pulmonary Embolism ◽  
Respiratory Failure ◽  
Cause Of Death ◽  
Causes Of Death ◽  
Lung Tumor ◽  
Diffuse Alveolar Damage ◽  
Pulmonary Hemorrhage ◽  
Tumor Burden ◽  
Tumor Emboli

Context.—The causes of death for patients with lung cancer are inadequately described. Objective.—To categorize the immediate and contributing causes of death for patients with lung cancer. Design.—The autopsies from 100 patients who died of lung cancer between 1990 and February 2011 were analyzed. Results.—Tumor burden was judged the immediate cause of death in 30 cases, including 26 cases of extensive metastases and 4 cases with wholly or primarily lung tumor burden (causing respiratory failure). Infection was the immediate cause of death for 20 patients, including 8 with sepsis and 12 with pneumonia. Complications of metastatic disease were the immediate causes of death in 18 cases, including 6 cases of hemopericardium from pericardial metastases, 3 from myocardial metastases, 3 from liver metastases, and 3 from brain metastases. Other immediate causes of death were pulmonary hemorrhage (12 cases), pulmonary embolism (10 cases, 2 tumor emboli), and pulmonary diffuse alveolar damage (7 cases). From a functional (pathophysiologic) perspective, respiratory failure could be regarded as the immediate cause of death (or mechanism of death) in 38 cases, usually because of a combination of lung conditions, including emphysema, airway obstruction, pneumonia, hemorrhage, embolism, resection, and lung injury in addition to the tumor. For 94 of the 100 patients, there were contributing causes of death, with an average of 2.5 contributing causes and up to 6 contributing causes of death. Conclusions.—The numerous and complex ways lung cancer kills patients pose a challenge for efforts to extend and improve their lives.

Analysis of competing risks of causes of death and their variation over different time periods in Hodgkin disease

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 18528-18528
Author(s):  
P. España ◽  
A. Sanchez ◽  
P. Espinosa ◽  
V. Massip ◽  
R. Perez-Maestu ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Competing Risks ◽  
Hodgkin's Disease ◽  
Causes Of Death ◽  
Hodgkin’S Disease ◽  
The Other ◽  
University Hospital ◽  
Time Periods

18528 Background: Hodgkin’s disease is put forward as a model of curable illness. However, long-term studies show an excessive mortality in relation to the general population. The only way for detecting these causes are the long-term follow-up clinical studies, even these long-term follow-ups may not be fully representative of current causes of death. Methods: All patients diagnosed with HD at the University Hospital “Clínica Puerta de Hierro” between 1967 and 2003 were included. The competing risks of causes of death and the vital situation were examined in three time periods. Three cohorts were compared: cohort A with patients treated before 1980, B with those treated 1981–1986 and C from 1986 on. Results: We studied 534 patients, with a median follow-up time of 9.1 years for the whole cohort. The 5, 15 and 20-year Kaplan-Meier survival estimates for all patients were 81%, 72% and 65%, respectively. At the close of the study, 337 (63.1%) were alive and 170 (31.8%) had died. In general, the most common cause was the progress of Hodgkin’s disease, followed by deaths due to a second tumor. By time periods, we found statistically significant differences between cohort A and the other two cohorts, with less LD and MC histology, fewer advanced stages and fewer combined treatments in the latter. Between cohorts B and C there were only differences in the histological results, with less LD and MC and increased NS in the latter. Survival was significantly worse in the first period than in the other two (p<0.001) and in the three periods the main cause of death was tumor progression. Conclusions: The progression of Hodgkin’s disease is the main cause of death in all the periods studied. Over time a clear reduction in death related to the toxicity of treatments was seen. In the light of our results, the question is posed as to whether the survival and causes of death series for those patients treated since the 1970s are telling us about a real situation. Patients die now for reasons that are different from in the 1970s and this is important when planning preventive and clinical research activity. No significant financial relationships to disclose.

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