Letter to the editor
To assess mortality from COVID-19 in patients with comorbidities, it is crucial to perform an autopsy
Josef Finsterer
Neurology & Neurophysiology Center, Vienna, Austria
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"documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Vacunas. 2023;24:402-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:9 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the editor</span>" "titulo" => "The impact of vaccination against monkeypox on risk of mpox reinfection" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "402" "paginaFinal" => "403" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Farhad Dadgar, Jalil Rouhani, Fatemeh Dehghani, Masoud Keikha" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Farhad" "apellidos" => "Dadgar" ] 1 => array:2 [ "nombre" => "Jalil" "apellidos" => "Rouhani" ] 2 => array:2 [ "nombre" => "Fatemeh" "apellidos" => "Dehghani" ] 3 => array:2 [ "nombre" => "Masoud" "apellidos" => "Keikha" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2445146023000705?idApp=UINPBA00004N" "url" => "/24451460/0000002400000004/v2_202401230726/S2445146023000705/v2_202401230726/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the editor</span>" "titulo" => "To assess mortality from COVID-19 in patients with comorbidities, it is crucial to perform an autopsy" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "404" "paginaFinal" => "405" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Josef Finsterer" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Josef" "apellidos" => "Finsterer" "email" => array:1 [ 0 => "fifigs1@yahoo.de" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Neurology & Neurophysiology Center, Vienna, Austria" "identificador" => "af0005" ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="p0010" class="elsevierStylePara elsevierViewall">With interest we read the article by Jesmani et al. about a retrospective study on the clinical presentation and outcome of 665 COVID-19 patients admitted to Kermanshah hospital between 22 October 2020 and 22 November 2020.<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a> In this study, 85% of patients had oxygen saturation (SPO<span class="elsevierStyleInf">2</span>) <<span class="elsevierStyleHsp" style=""></span>93% on admission. The most common comorbidities were arterial hypertension, diabetes, and cardiovascular disease. Among 655 of the included COVID-19 patients, 82 died within 7 days after admission. The in-hospital fatality rate was 12.33%. Each one unit increase in SPO<span class="elsevierStyleInf">2</span> increased the odds of survival by 0.88 times while each one day increase in the length of the intensive care unit (ICU) stay decreased the odds of death by 0.49 times.<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a> The study is excellent, but has limitations that are cause of concern and should be discussed.</p><p id="p0015" class="elsevierStylePara elsevierViewall">The main limitation of the study is its retrospective design. Retrospective studies rely on data collected by many others and can usually neither be controlled nor corrected. There is also the disadvantage that missing data cannot be supplemented and that open questions concerning individual data cannot be inquired and obtained.</p><p id="p0020" class="elsevierStylePara elsevierViewall">Other limitations of the study are that none of the patients that died underwent autopsy and that there is no definition in the methodology for “death from COVID-19”.<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a> Autopsy is critical particularly in overlap cases, in which the cause of death could be due to several different diseases that were present simultaneously. As to the lack of definition of specific cause of death being COVID-19, and because causes of death are usually not easy to identify unequivocally, it is crucial to assess how myocardial infarction or ischemic stroke, unrelated to the current SARS-CoV-2 infection, were delineated from SARS-CoV-2 pneumonia as the cause of death. Were complications from SARSCoV-2 infection, such as venous sinus thrombosis (VST), ischemic stroke, encephalitis, status epilepticus regarded as death due to COVID-19 or only SARS-CoV-2 pneumonia or acute respiratory distress syndrome (ARDS)?</p><p id="p0025" class="elsevierStylePara elsevierViewall">Besides, there is no mention of treatment administered to these patients during hospitalisation. It is known that several drugs administered to SARS-CoV-2 infected patients (e.g. chloroquine) can be harmful and can increase severity of the disease.<a class="elsevierStyleCrossRef" href="#bb0010"><span class="elsevierStyleSup">2</span></a> Therefore, the medications given during hospitalisation should be provided.</p><p id="p0030" class="elsevierStylePara elsevierViewall">Statistics strongly depend on the quality of data and comprehensiveness of its collection. How did the authors ensure that diagnosis of SARS-CoV-2, documentation of SARS-CoV-2 infection in the records, number of comorbidities, and outcome were correctly registered and reported?</p><p id="p0035" class="elsevierStylePara elsevierViewall">Because the study discerned between confirmed, suspected and probable COVID-19, we should be able to know in how many patients the infection was confirmed by a positive RT-PCR, in how many by lung computerized tomography (CT), and in how many was COVID-19 diagnosed upon clinical suspicion alone. Lung CT can be suspicious of COVID-19 but does not definitively confirm the infection. The number of positive lung CT without a positive RT-PCR should be available and these cases should have been excluded from the evaluation.</p><p id="p0040" class="elsevierStylePara elsevierViewall">Overall, this interesting study has limitations that question the results and their interpretation. Addressing these issues would strengthen the conclusions and could improve the status of the study. To assess mortality due to COVID-19 in patients with comorbidities, it is crucial to perform autopsy.</p><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">Funding</span><p id="p0045" class="elsevierStylePara elsevierViewall">No funding was received</p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020">Author contribution</span><p id="p0050" class="elsevierStylePara elsevierViewall">JF: design, literature search, discussion, first draft, critical comments, final approval.</p></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0025">Disclosures</span><p id="p0055" class="elsevierStylePara elsevierViewall">The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p></span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0030">Compliance with ethics guidelines</span><p id="p0060" class="elsevierStylePara elsevierViewall">This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "s0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "s0010" "titulo" => "Author contribution" ] 2 => array:2 [ "identificador" => "s0015" "titulo" => "Disclosures" ] 3 => array:2 [ "identificador" => "s0020" "titulo" => "Compliance with ethics guidelines" ] 4 => array:2 [ "identificador" => "xack724192" "titulo" => "Acknowledgements" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Demographic and clinical characteristics and outcomes of COVID-19 patients admitted to a university hospital in the west of Iran: a retrospective study in the third wave" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Y. 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Varallo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Rev Panam Salud Publica" "fecha" => "2022 Oct 25" "numero" => "46" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack724192" "titulo" => "Acknowledgements" "texto" => "<p id="p0065" class="elsevierStylePara elsevierViewall">Statement of Ethics: a) The study was approved by the institutional review board (responsible: Finsterer J.) at the 4<span class="elsevierStyleSup">th</span> November 2022. b) Written informed consent was obtained from the patient for publication of the details of their medical case and any accompanying images.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/24451460/0000002400000004/v2_202401230726/S2445146023000717/v2_202401230726/en/main.assets" "Apartado" => array:4 [ "identificador" => "91117" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24451460/0000002400000004/v2_202401230726/S2445146023000717/v2_202401230726/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2445146023000717?idApp=UINPBA00004N" ]
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