Causes of Death and Comorbidities in Patients with COVID-19

Elezkurtaj, S.; Greuel, S.; Ihlow, J.; Michaelis, E.; Bischoff, P.; Kunze, C. A.; Sinn, B. V.; Gerhold, M.; Hauptmann, K.; Ingold-Heppner, B.; Miller, F.; Herbst, H.; Corman, V. M.; Martin, H.; Heppner, F. L.; Horst, D.

Infection 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.