A Theoretical Death Map of Patients with COVID-19: A Single Center Experience

Given the increase in mortality from COVID-19 disease, understanding the causal chain leading to death in patients with this disease will be of particular importance. This study aimed to draw the death map of patients with COVID-19 in BESAT hospital (West of Iran), based on investigating the underlying, intermediate, and terminal causes of death in this group of patients.

To draw the death map of patients with COVID-19 in this cross-sectional study, the death certificate and medical records of 183 COVID-19 patients who died at BESAT Hospital in Hamadan (West of Iran) in 2020 were reviewed. The cases in which the underlying cause of death was COVID-19 were reviewed. A checklist was used to collect the data. It was designed based on the international form of medical certificate of cause of death (issued by WHO). The collected data were analyzed by SPSS software version 23.

The most prevalent underlying causes of death were COVID-19 (60.7%), COVID-19-related pneumonia (19.1%), acute respiratory distress syndrome (10.9%), and severe sepsis (9.8%). Hypertension (8.2%), diabetes (6.0%), seizures (3.8%), and ischemic heart disease (2.2%) were the most influential conditions affecting death. The number of deaths due to the terminal cause of acute respiratory distress syndrome in women (22.5%) was much higher than in men (7.1%) (P-value=0.041). Findings indicated that most patients died from four main pathways originating from COVID-19, leading to causes such as sepsis, ARDS, myocarditis, MI, and PTE.

The results indicate that health officials and healthcare providers should be able to identify and monitor patients with chronic diseases and implement effective plans to prevent COVID-19. Physicians should also take important steps in offices, clinics, and hospitals, such as conducting early echocardiography in children, providing respiratory support, and preventing deep vein thrombosis in adults during hospitalization. It is also essential to inform the public through audio and video media, including radio and television.