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A COVID-19-association-dependent categorization of death causes in 100 autopsy cases
GeroScience ( IF 5.6 ) Pub Date : 2021-09-11 , DOI: 10.1007/s11357-021-00451-w
Krisztina Danics 1 , Adrián Pesti 2 , Klára Törő 1 , Noémi Kiss-Dala 3 , János Szlávik 3 , Botond Lakatos 3 , Andrea Radnai 4 , Tamás Balázs 4 , Miklós Bacskai 4 , Deján Dobi 2 , Tibor Várkonyi 2 , Tibor Glasz 2 , Gábor Lotz 2 , András Kiss 2 , Zsuzsa Schaff 2 , István Vályi-Nagy 3
Affiliation  

From March through December 2020, 100 autopsies were performed (Semmelweis University, Budapest, Hungary), with chart review, of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection demonstrated by real-time reverse-transcription polymerase chain reaction testing (mean age, 74.73 years, range 40–102 years; 50 males, mean age 71.96 years, and 50 females, mean age 77.5 years). Classified by the date of death, 21 cases were from the pandemic’s “first wave” (March through July) and 79 from the “second wave” (August through December). Three mortality categories were defined by relevance of SARS-CoV-2 infection: (1) “strong” association (n=57), in which COVID-19 was primary responsible for death; (2) “contributive” association (n=27), in which a pre-existing condition independent of COVID-19 was primary responsible for death, albeit with substantial COVID-19 co-morbidity; (3) “weak” association (n=16), in which COVID-19 was minimally or not at all responsible for death. Distributions among categories differed between the first wave, in which the “contributive” association cases dominated (strong: 24%, contributive: 48%, weak: 28%), and the second wave, in which the “strong” association cases dominated (strong: 66%, contributive: 21%, weak: 13%). Charted co-morbidities included hypertension (85 %), cardiovascular diseases (71 %), diabetes (40 %), cerebrovascular diseases (31 %), chronic respiratory diseases (30 %), malignant tumors (20 %), renal diseases (19 %), diseases of the central nervous system (15 %), and liver diseases (6 %). Autopsy evaluation analyzed alterations on macroscopy as well as findings on microscopy of scanned and scored sections of formalin-fixed, paraffin-embedded tissue samples (50–80 blocks/case). Severity of histological abnormalities in the lung differed significantly between “strong” and “contributive” (p<0.0001) and between “strong” and “weak” categories (p<0.0001). Abnormalities included diffuse alveolar damage, macrophage infiltration, and vascular and alveolar fibrin aggregates (lung), with macro- and microvascular thrombi and thromboemboli (lung, kidney, liver). In conclusion, autopsies clarified in what extent COVID-19 was responsible for death, demonstrated the pathological background of clinical signs and symptoms, and identified organ alterations that led to the death. Clinicopathologic correlation, with conference discussions of severity of co-morbidities and of direct pathological signs of disease, permitted accurate categorization of cause of death and COVID-19 association as “strong,” “contributive,” or “weak.” Lung involvement, with reduced ventilatory capacity, was the primary cause of death in the “strong” and “contributive” categories. Shifts in distribution among categories, with “strong” association between COVID-19 and death dominating in the second wave, may reflect improved clinical management of COVID-19 as expertise grew.



中文翻译:

100 例尸检病例中与 COVID-19 相关的死亡原因分类

从 2020 年 3 月到 2020 年 12 月,对实时逆转录聚合酶链证实的严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 感染患者进行了 100 次尸检(匈牙利布达佩斯塞梅尔维斯大学),并进行了图表审查反应测试(平均年龄 74.73 岁,范围 40-102 岁;50 名男性,平均年龄 71.96 岁,50 名女性,平均年龄 77.5 岁)。按死亡日期分类,21 例来自大流行的“第一波”(3 月至 7 月),79 例来自“第二波”(8 月至 12 月)。根据 SARS-CoV-2 感染的相关性定义了三个死亡率类别:(1)“强”关联(n = 57),其中 COVID-19 是导致死亡的主要原因;(2) “贡献”协会(n=27),其中与 COVID-19 无关的既存疾病是导致死亡的主要原因,尽管有大量 COVID-19 合并症;(3)“弱”关联(n = 16),其中 COVID-19 对死亡的影响最小或根本没有。第一波的类别分布不同,其中“贡献”关联案例占主导地位(强:24%,贡献:48%,弱:28%)和第二波,其中“强”关联案例占主导地位(强:66%,贡献:21%,弱:13%)。图表中的合并症包括高血压(85%)、心血管疾病(71%)、糖尿病(40%)、脑血管疾病(31%)、慢性呼吸道疾病(30%)、恶性肿瘤(20%)、肾脏疾病(19 %)、中枢神经系统疾病 (15%) 和肝脏疾病 (6%)。尸检评估分析了肉眼观察的变化以及福尔马林固定、石蜡包埋的组织样本(50-80 块/病例)的扫描和评分切片的显微镜检查结果。“强”和“贡献”(p <0.0001)以及“强”和“弱”类别(p<0.0001)。异常包括弥漫性肺泡损伤、巨噬细胞浸润、血管和肺泡纤维蛋白聚集(肺),以及大血管和微血管血栓和血栓栓塞(肺、肾、肝)。总之,尸检阐明了 COVID-19 在多大程度上导致了死亡,证明了临床体征和症状的病理背景,并确定了导致死亡的器官改变。临床病理学相关性,会议讨论了合并症的严重性和疾病的直接病理征兆,允许将死因和 COVID-19 关联准确分类为“强”、“有贡献”或“弱”。肺受累,通气能力降低,是“强”和“贡献”类别的主要死因。类别之间的分布变化,

更新日期:2021-09-13
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