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@ARTICLE{Elezkurtaj:155622,
      author       = {Elezkurtaj, Sefer and Greuel, Selina and Ihlow, Jana and
                      Michaelis, Edward Georg and Bischoff, Philip and Kunze,
                      Catarina Alisa and Sinn, Bruno Valentin and Gerhold, Manuela
                      and Hauptmann, Kathrin and Ingold-Heppner, Barbara and
                      Miller, Florian and Herbst, Hermann and Corman, Victor and
                      Martin, Hubert and Radbruch, Helena and Heppner, Frank L and
                      Horst, David},
      title        = {{C}auses of death and comorbidities in hospitalized
                      patients with {COVID}-19.},
      journal      = {Scientific reports},
      volume       = {11},
      number       = {1},
      issn         = {2045-2322},
      address      = {[London]},
      publisher    = {Macmillan Publishers Limited, part of Springer Nature},
      reportid     = {DZNE-2021-00790},
      pages        = {4263},
      year         = {2021},
      abstract     = {Infection by the new corona virus strain SARS-CoV-2 and its
                      related syndrome COVID-19 has been associated with more than
                      two million 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
                      pre-existing health conditions to death yet is missing,
                      which can be reliably established by autopsy only. We
                      performed full body autopsies on 26 patients that had died
                      after SARS-CoV-2 infection and COVID-19 at the Charité
                      University Hospital Berlin, Germany, or at associated
                      teaching hospitals. We systematically evaluated causes of
                      death and pre-existing health conditions. Additionally,
                      clinical records and death certificates were evaluated. We
                      report 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 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.},
      keywords     = {Adult / Aged / Aged, 80 and over / Autopsy / Berlin:
                      epidemiology / COVID-19: complications / COVID-19: mortality
                      / COVID-19: therapy / COVID-19: virology / Cause of Death /
                      Comorbidity / Female / Hospital Mortality / Hospitals,
                      Teaching: statistics $\&$ numerical data / Humans /
                      Hypertension: epidemiology / Male / Middle Aged / Multiple
                      Organ Failure: mortality / Multiple Organ Failure: virology
                      / Myocardial Ischemia: epidemiology / Obesity: epidemiology
                      / Prospective Studies / SARS-CoV-2: isolation $\&$
                      purification / Shock, Septic: mortality / Shock, Septic:
                      virology},
      cin          = {AG Heppner},
      ddc          = {600},
      cid          = {I:(DE-2719)1810007},
      pnm          = {353 - Clinical and Health Care Research (POF4-353)},
      pid          = {G:(DE-HGF)POF4-353},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:33608563},
      pmc          = {pmc:PMC7895917},
      doi          = {10.1038/s41598-021-82862-5},
      url          = {https://pub.dzne.de/record/155622},
}