COVID-19 mortality is most frequent in men 60-77 years old with acute lung injury.
One of the greatest mysteries of the COVID-19 pandemic is why some people are asymptomatic while other have fatal disease. Certain characteristics, such as advanced age, respiratory complications, and other comorbidities, are known to increase the likelihood of COVID-19 mortality. One study, however, sought to determine the profile of a typical COVID-19 decedent.
The study, published in Current Medical Research and Opinion, examined postmortem findings to help establish therapeutic strategies to reduce COVID-19 mortalities. The investigators systematically reviewed autopsy cases and associated comorbidities to create a profile of the deceased and likelihood of time to death.
The investigators conducted a search of the electronic databases Pubmed, Scopus, Web of Science, Wiley Online Library, and Scientific Electronic Library Online (SciELO). They identified a total of 25 articles detailing 140 complete COVID-19 autopsies. The final analysis included 92 men and 48 women.
The investigators found that the most prevalent comorbidity in deceased COVID-19 patients was vascular disease. The patients with vascular disease, heart disease, or diabetes died in a significantly shorter time than patients who did not have these comorbidities.
Most of the autopsies were focused on the lungs. The microscopic postmortem findings most commonly reported Diffuse Alveolar Damage (DAD) in the proliferative phase. In these patients, time to COVID-19 death was significantly shortened. Notably, however, the patients older than 80 years frequently presented with fibrotic phase of DAD at the time of their death.
“It is the first time that the injuries found in an autopsy and the comorbidities presented by a patient—conditions other than the primary disease— are associated with the likelihood of quicker death,” said Jaime Martín-Martín, a co-author of the study and a scientist at the University of Malaga’s Department of Legal and Forensic Medicine.
After the lungs, the kidney was the second organ most affected by COVID-19 infection. Thrombosis and tubular damage were most commonly observed in the kidneys of the deceased. Third was the liver, with congestion and necrosis.
The investigators emphasized that autopsies should be performed by examining organs other than the lungs. Autopsies, they wrote, “should be a key element to understand any disease, but especially in newly emerged diseases like COVID-19.” Completing in-depth autopsies can paint a more complete picture of COVID-19 mortality risks.