Undetected Causes of Death in Hospitalized Elderly with COVID-19: Lessons from Autopsy

Abstract

Background: Mechanisms and causes of death in older patients with SARS-CoV-2 infection are still poorly understood. Methods: We conducted in a retrospective monocentric study, a clinical chart review and post-mortem examination of patients aged 75 years and older hospitalized in acute care and positive for SARS-CoV-2. Full body autopsy and correlation with clinical findings and suspected causes of death were done. Results: Autopsies were performed in 12 patients (median age 85 years; median of 4 comorbidities, mainly hypertension and cardiovascular disease). All cases showed exudative or proliferative phases of alveolar damage and/or a pattern of organizing pneumonia. Causes of death were concordant in 6 cases (50%), and undetected diagnoses were found in 6. Five patients died from hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19), five had another associated diagnosis and two died from alternative causes. Deaths that occurred in the second week were related to SARS-CoV-2 pneumonia whereas those occurring earlier were related mainly to heart failure and those occurring later to complications. Conclusions: Although COVID-19 hypoxemic respiratory failure was the most common cause of death, post-mortem pathological examination revealed that acute decompensation from chronic comorbidities during the first week of COVID-19 and complications in the third week contributed to mortality.

Measuring anxiety and fear of Covid-19 among older people: psychometric properties of anxiety and fear of Covid-19 scale (AMICO) in Spain

“…Previous studies on disaster situations have highlighted the greater vulnerability of the elderly in these scenarios, recognising this group as one that is not adequately cared for in these cases, which is why care should be prioritised to reduce their morbidity and mortality [2]. This population has proven to be a group particularly at risk as regards the effects of the COVID-19 pandemic [1,3,4], suffering higher rates of hospital admissions, more sequelae following illness, and higher mortality than other population age groups, both for institutionalised and non-institutionalised elderly [5][6][7].…”

Findings and inferences from full autopsies, minimally invasive autopsies and biopsy studies in patients who died as a result of COVID19 — A systematic review

“…The deaths that occurred in the second week were related to SARS-CoV-2 pneumonia. The deaths occurring earlier were noted from heart failure and those occurring later were due to complications [ 39 ].…”

“…Gross changes observed Subarachnoid haemorrhage, cortical venous thrombosis [27]. Intraparenchymal ischemia, infarcts [39,85,99] Microscopic/histopathological changes noted Extensive inflammatory response [28,95] Intraparenchymal intravascular microthrombi, ischemia, infarcts [22,49,101] Acute perivascular disseminated encephalomyelitis (ADEM) like appearance [54].…”

“…Marked upregulation of IL (interleukin) 6, TNF (tumour necrosis factor) alpha, IL1 beta, p38, IL8, and caspase3 in the endothelium – involved in the basement membrane disruption, endothelitis, duplication [ 18 ] CNS Gross changes observed Subarachnoid haemorrhage, cortical venous thrombosis [ 27 ]. Intraparenchymal ischemia, infarcts [ 39 , 85 , 99 ] Microscopic/histopathological changes noted Extensive inflammatory response [ 28 , 95 ] Intraparenchymal intravascular microthrombi, ischemia, infarcts [ 22 , 49 , 101 ] Acute perivascular disseminated encephalomyelitis (ADEM) like appearance [ 54 ]. Liver Microscopic/histopathological changes noted Macrovesicular steatosis [ 6 , 10 , 30 , 35 , 40 ] Centrilobular necrosis [ 10 , 87 ] Extensive inflammatory response [ 95 ] Hepatitis [ 25 , 87 ] Platelet-rich thrombi.…”

Clinical Features of COVID-19 in Elderly Patients: Tools for Predicting Outcomes Are Needed

“…Multimorbidity also significantly reduced the survival rate of patients infected with COVID-19 [21]. The cause of death in patients infected with COVID-19 was investigated post mortem using clinical chart review and autopsy [22]. Along with hypoxemic respiratory failure, acute decompensation of pre-existent comorbidities within the first week of infection was the most common cause of death [22].…”