Sci Rep . Prospective postmortem evaluation of 735 consecutive SARS-CoV-2-associated death cases

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Sci Rep


. 2021 Sep 29;11(1):19342.
doi: 10.1038/s41598-021-98499-3.
Prospective postmortem evaluation of 735 consecutive SARS-CoV-2-associated death cases


Antonia Fitzek ^{# 1} , Julia Schädler ^{# 2} , Eric Dietz ^{# 1} , Alexandra Ron ^{# 1} , Moritz Gerling ¹ , Anna L Kammal ¹ , Larissa Lohner ¹ , Carla Falck ¹ , Dustin Möbius ¹ , Hanna Goebels ¹ , Anna-Lina Gerberding ¹ , Ann Sophie Schröder ¹ , Jan-Peter Sperhake ¹ , Anke Klein ¹ , Daniela Fröb ¹ , Herbert Mushumba ¹ , Sandra Wilmes ¹ , Sven Anders ¹ , Inga Kniep ¹ , Fabian Heinrich ¹ , Felicia Langenwalder ¹ , Kira Meißner ¹ , Philine Lange ¹ , Antonia Zapf ³ , Klaus Püschel ¹ , Axel Heinemann ¹ , Markus Glatzel ⁴ , Jakob Matschke ⁴ , Martin Aepfelbacher ⁵ , Marc Lütgehetmann ⁵ , Stefan Steurer ⁶ , Christoph Thorns ⁷ , Carolin Edler ¹ , Benjamin Ondruschka ⁸



Affiliations

• PMID: 34588486
• DOI: 10.1038/s41598-021-98499-3

Abstract

Coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic with significant mortality. Accurate information on the specific circumstances of death and whether patients died from or with SARS-CoV-2 is scarce. To distinguish COVID-19 from non-COVID-19 deaths, we performed a systematic review of 735 SARS-CoV-2-associated deaths in Hamburg, Germany, from March to December 2020, using conventional autopsy, ultrasound-guided minimally invasive autopsy, postmortem computed tomography and medical records. Statistical analyses including multiple logistic regression were used to compare both cohorts. 84.1% (n = 618) were classified as COVID-19 deaths, 6.4% (n = 47) as non-COVID-19 deaths, 9.5% (n = 70) remained unclear. Median age of COVID-19 deaths was 83.0 years, 54.4% were male. In the autopsy group (n = 283), the majority died of pneumonia and/or diffuse alveolar damage (73.6%; n = 187). Thromboses were found in 39.2% (n = 62/158 cases), pulmonary embolism in 22.1% (n = 56/253 cases). 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. Our study highlights the need for mortality surveillance and postmortem examinations. The vast majority of individuals who died directly from SARS-CoV-2 infection were of advanced age and had multiple comorbidities.