Cause-specific death in hospitalized individuals infected with SARS-CoV-2: More than just acute respiratory failure or thromboembolic events.

Abstract

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background</jats:bold>: Infection with SARS-CoV-2 is becoming the leading cause of death in most countries during the 2020 pandemic.<jats:bold>Objective</jats:bold>: to assess the association between COVID-19 and cause-specific death.<jats:bold>Design</jats:bold>: Retrospective cohort study.<jats:bold>Setting and Participants</jats:bold>: We included data from inpatients diagnosed with COVID-19 between March 18 and April 21, 2020, who died during their hospital stay. Demographic, clinical and management data were collected. Causes of death were ascertained by review of medical records.<jats:bold>Results</jats:bold>: The sample included 100 individuals. The median age was 85 (IQR 15), 59% were men. Fifteen patients (15%) died from complications unrelated to COVID-19. In univariate analysis, these patients compared to those who died from COVID-19 complications had a greater likelihood of dementia (47% vs 20%) and dependency in activities of daily living (93% vs 48%), higher Charlson comorbidity index scores (6 vs 5), a lower likelihood of fever at diagnosis (47% vs 77%), and higher lymphocyte counts (1,000 vs 660). In multivariate analysis, patients were older (OR 1.10, 95% CI 1.00–1.23) and more often had heart failure (OR 5.58, 95% CI 1.09–28.66). The presence of X-ray infiltrates was uncommon (OR 0.03, 95% CI 0.01–0.17). A higher percentage of patient deaths from causes unrelated to COVID-19 complications occurred during the two first weeks of the pandemic.<jats:bold>Conclusions</jats:bold>: Fifteen percent of patients with COVID-19 died from causes unrelated to COVID-19 complications. Most of these patients had more comorbidities and were frail and elderly. These findings can partially explain the excess mortality in older people.</jats:p>