Died with or Died of? Development and Testing of a SARS CoV-2 Significance Score to Assess the Role of COVID-19 in the Deaths of Affected Patients

Giorgetti, Arianna; Orazietti, Vasco; Busardò, Francesco Paolo; Pirani, Filippo; Giorgetti, Raffaele

doi:10.3390/diagnostics11020190

Cited by 6 publications

(7 citation statements)

References 82 publications

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“…Finally, the findings in this case series should be interpreted in light of several limitations that included: (1) the small sample size, which was mostly related to restriction of autopsy examination to medicolegal cases; (2) potential selection bias since all deaths were considered as medicolegal cases; (3) missing of full clinical history data in a few cases, including the history of COVID-19 vaccine uptake among the four cases included following the start of vaccination campaign in Jordan, besides the lack of data on microbiologic testing to rule out bacterial superinfections; (4) the approach used to stratify the cases into “died of COVID-19” vs. “died with SARS-CoV-2 infection” depended on the detection of DAD solely. Thus, future studies should benefit from a refined approach of classification including consideration of detailed medical records from the included cases, as well as the full utility of postmortem radiology, besides toxicologic investigations [ 20 ]; and finally (5) virtual autopsy (virtopsy) was not conducted in this study and should be considered in the future studies considering its promising role for postmortem investigation in the context of resolving disputed cases of COVID-19 deaths.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the rapid availability of extensive and comprehensive research on COVID-19, several aspects of the disease have not been fully elucidated yet, one of which is labeling the deaths with positive SARS-CoV-2 testing results as COVID-19–related mortalities despite the absence of typical findings of the disease [ 11 , 19 , 20 ]. Thus, autopsy examination can be the sole method to reach a definitive conclusion about the genuine cause of death in such a scenario [ 21 ].…”

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confidence: 99%

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Postmortem lung and heart examination of COVID-19 patients in a case series from Jordan

Abdaljaleel

Tawalbeh

Sallam³

et al. 2023

JPTM

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Background: Coronavirus disease 2019 (COVID-19) has emerged as a pandemic for more than 2 years. Autopsy examination is an invaluable tool to understand the pathogenesis of emerging infections and their consequent mortalities. The aim of the current study was to present the lung and heart pathological findings of COVID-19–positive autopsies performed in Jordan. Methods: The study involved medicolegal cases, where the cause of death was unclear and autopsy examination was mandated by law. We included the clinical and pathologic findings of routine gross and microscopic examination of cases that were positive for COVID-19 at time of death. Testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed through molecular detection by real-time polymerase chain reaction, serologic testing for IgM and electron microscope examination of lung samples. Results: Seventeen autopsies were included, with male predominance (76.5%), Jordanians (70.6%), and 50 years as the mean age at time of death. Nine out of 16 cases (56.3%) had co-morbidities, with one case lacking such data. Histologic examination of lung tissue revealed diffuse alveolar damage in 13/17 cases (76.5%), and pulmonary microthrombi in 8/17 cases (47.1%). Microscopic cardiac findings were scarcely detected. Two patients died as a direct result of acute cardiac disease with limited pulmonary findings. Conclusions: The detection of SARS-CoV-2 in postmortem examination can be an incidental or contributory finding which highlights the value of autopsy examination to determine the exact cause of death in controversial cases.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Postmortem lung and heart examination of COVID-19 patients in a case series from Jordan

Abdaljaleel

Tawalbeh

Sallam³

et al. 2023

JPTM

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“…Other rating scales, such as the Hamburg scoring system, indicate the likelihood of death due to COVID-19 based on clinical judgment, similar to the one used here. 13 While this adds a layer of complexity to COVID-19 statistics, it could provide a more accurate fatality rate for a SARS-CoV-2 infection. Standardized training in assessing COVID-19 fatalities or death certification may also be beneficial.…”

Section: Discussionmentioning

confidence: 99%

Cause of death in fatal cases associated with positive COVID-19 PCR tests

Peterson¹,

Fanous²,

Mallah³

et al. 2021

The Chronicles

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The response to the COVID-19 pandemic is heavily influenced by reported fatalities from the virus and, by implication, the criteria used to determine those fatalities. Given complications, such as the presence of comorbidities and limitations in testing, the World Health Organization (WHO) guidelines recommend counting both confirmed and suspected COVID-19 deaths as fatalities. While easily implementable, this method does little to indicate the degrees of certainty for a COVID-19 death, and thus concerns have arisen that this may overcount the number of COIVD-19 fatalities. In response, we developed and implemented a scoring system to determine the likelihood that COVID-19 contributed to patient death. Three reviewers independently assessed records of 47 patients who reportedly died from COVID-19. Greatest consensus was observed at the ends of the scoring spectrum, with twelve patients having complete consensus among reviewers. Intraclass correlation among the three reviewers was 0.52 (95% CI, 0.25-0.72). Middle scores had the greatest variability, possibly due to plausible alternative diagnoses, suggesting the potential for variability in death certification and the need for a scoring system that reports degrees of certainty. Although scoring rules can guide reviewers toward greater consensus about cause of death, in the absence of an objective criteria for COVID-19 disease, the determination of cause of death in paitents with positive PCR tests for SARS-CoV-2 who also have significant comorbid conditions will remain subjective. Keywords: COVID-19; fatality; cause of death

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“…We suggest a role for COVID-19 testing of dying patients in health facilities as postmortem testing will give a COVID-19 significant score, providing information on SARS-CoV-2-related deaths in many African countries (Giorgetti et al, 2021). In a Zambian postmortem surveillance study, SARS-CoV-2 was detected in 15.9% of the study cohort (Mwananyanda et al, 2021), further emphasising that COVID-19 cases in Africa are underreported due to inadequate testing.…”

Section: The Way Forwardmentioning

confidence: 94%

Low COVID-19 impact in Africa: The multifactorial Nexus

et al. 2021

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Africa has defied predictions of being the worst hit by the novel coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which has devastated Europe, the Americas, and some Asian countries. However, with a current second and third wave of the COVID-19 pandemic across other continents, pertinent questions have arisen regarding the lower disease severity and seemingly better outcomes in most African countries. Several factors have been proposed as discussed in this review including, underreporting, quick lockdown measures, effective public health intervention, younger population structure, cross-immunity and experience from fighting previous epidemics, such as the Ebola virus outbreak, previous infections or vaccinations, genetic predisposition, and tropical climate. We have discussed the implications of these factors on the magnitude of the outbreak and the better-than-expected outcomes observed in Africa. In addition, other potential factors like vitamin-D deficiency and chronic non-communicable diseases could predispose non-African regions to severe COVID-19 outcome. Therefore, this review further advocates for research to understand the precise mechanisms responsible for the pandemic’s relatively mild impact in Africa and proposed recommendations to prevent an infection surge.

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Died with or Died of? Development and Testing of a SARS CoV-2 Significance Score to Assess the Role of COVID-19 in the Deaths of Affected Patients

Cited by 6 publications

References 82 publications

Postmortem lung and heart examination of COVID-19 patients in a case series from Jordan

Postmortem lung and heart examination of COVID-19 patients in a case series from Jordan

Cause of death in fatal cases associated with positive COVID-19 PCR tests

Low COVID-19 impact in Africa: The multifactorial Nexus

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