COMORBIDITY AND CAUSE OF DEATH IN THE DIFFERENT VARIANTS OF SARS-COV-2 VIRUS, WITH CONTRIBUTION OF 20 AUTOPSY CASES

Abstract

Analyzing the clinical and epidemiological data of COVID-19 suggests that specific comorbidities increase the risk of infection leading to worse lung injury and an even higher risk of death. The most common comorbidities reported up till now are hypertension, cardiovascular diseases, and diabetes. Aim to study: The design of the study includes comorbidity of patients and cause of death in alfa, delta, and omicron variants of SARS-CoV-2 virus, histological changes in the lungs, thrombotic complications of coronavirus infection and laboratory tests concerning thrombotic changes. Materials and Methods: We systematically evaluated 20 autopsies of patients deceased by COVID-19 infection. Collecting data was from February 28th, 2020, until June 2022. The cases were diagnosed with a PCR (Polymerase Chain Reaction) test and a rapid antigen test. 10 of the deceased patients were from the first, second, third, and fourth wave (I group) infected predominantly with the alfa and delta variants of coronavirus (from March 2020 until October 2021), and 10 patients infected after that date with predominantly the omicron variant (II group). Results: Most patients were over 50 years of age with multiple co-morbidities (28-88, average 63.9). Post-mortem case studies have shown Arterial hypertension in 80% (I/II gr), 60%/90% of patients with chronic ischemic heart disease, chronic and acute ischemic brain disease in 30%/10%, atherosclerosis, 60%/90%, diabetes mellitus 30%/40%, obesity stage III, 100%/95%). Clinical laboratory studies, in connection with thrombotic complications, revealed the increased value of creatine kinase, fibrinogen, D-dimers, and CRP. Lymphopenia was observed in 60%.All of the cases with COVID-19 viral desquamative pneumonia, at different stages, developed vascular thrombosis in medium-sized pulmonary vessels. Two patients developed pulmonary thromboembolism. We established 5 patients with generalized thrombosis. Three patients were complicated by infarcts in the brain, kidney, and spleen. Conclusion: The autopsies revealed a consistent pattern of pulmonary alveolar damage and generalized vascular/thrombotic disease in patients with frequent co-morbidities. The high frequency of generalized thrombotic complications was observed in predominant alfa and delta variants of the infection, while in the group with the omicron prevailing variant, the lung lesions were dominant, without extrapulmonary thrombotic complications, which we explain by the effective antithrombotic therapy. Major complications in these patients were secondary bacterial infection, sepsis, and respiratory distress syndrome.