Analysis of the possibility of the influence of complications of a clinically mild form of COVID-19 on the cause of death (case study)

The risk of death of a patient from COVID-19 is affected by the severity of the disease itself, the presence and severity of concomitant (comorbid/competing) pathology, and the availability of medical care. Obtaining information during a selective in-depth clinical and pathoanatomic analysis of fatal observations is of great relevance. The aim of the study: to analyze the possibility of the influence of mild COVID-19 complications on the cause of death according to pathologic and morphological data. The analysis of medical documentation, sectional material and forensic medical examination data provided by the Pskov Regional Bureau of Forensic Medical Examination was carried out. Patient N., 39 years old, was taken by ambulance to the city hospital from the pool with the diagnosis: condition after a series of seizures. Despite all the measures taken, the phenomena of cerebral edema progressed. Two days later, death was pronounced. Diagnosis: asphyxia during drowning. Histologically: fields of loss of nerve cells of the brain; circulatory disorders in the form of venous fullness with erythrocyte sludge in capillaries and venules, which are one of the leading complications. With hypoxemia, the bone marrow releases immature red blood cells into the bloodstream, which are prone to gluing and creating a sludge phenomenon. Hypoxic erythrocytosis often leads to death. Another important aspect is the connection between a seizure attack and COVID-19, as a manifestation of a viral invasion of the central nervous system and/or pneumonia with hypoxemia, leading to brain damage and seizures. Even with a mild form of the disease, it is possible to develop exercise intolerance. In the case under consideration, the coronavirus could become a trigger of epiactivity in the patient. Conclusions: based on the data of forensic medical examination and laboratory materials, it can be assumed that COVID-19 led to multilevel organic lesions of tissues and organs that could cause asphyxia. This is evidenced by perivascular and pericellular edema of the brain, erythrocyte sludge in blood vessels.

1. Wang D., Hu B., Hu C. et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA, 2020, vol. 323(11), pp. 1061–1069. doi: https://doi.org/10.1001/jama.2020.1585

2. Baumann T., Delgado J., Montserrat E. CLL and COVID19 at the Hospital Clinic of Barcelona: an interim report. Leukemia, 2020, vol. 34, pp. 1954–1956. doi: https://doi.org/10.1038/s41375-020-0870-5

3. Arutyunov G.P., Tarlovskaya E.I., Arutyunov A.G., et al. Mezhdunarodnyy registr «Analiz dinamiki komor-bidnykh zabolevaniy u patsiyentov, perenesshikh infitsiroVaniye SARS-CoV-2» (AKTIV SARS-CoV-2): analiz prediktorov neblagopriyatnykh iskhodov ostroy stadii novoy koronavirusnoy infektsii [International register “Dynamics analysis of comorbidities in SARS-CoV-2 survivors” (AKTIV SARS-CoV-2): analysis of predictors of short-term adverse outcomes in COVID-19]. Rossiyskiy kardiologicheskiy zhurnal — Russian Journal of Cardiology, 2021, vol. 26(4), p. 4470. doi:10.15829/1560-4071-2021-4470

4. Ruan Q., Yang K., Wang W., Jiang L., Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med., 2020, vol. 46(5), pp. 846-848. DOI: https://doi.org/10.1007/s00134-020-05991-x

5. Frank G.A., Kovalev A.V., et al. Issledovanie umershih s podozreniem na koronavirusnuju infekciju (COVID-19). Vremennye metodicheskie rekomendacii [Investigation of the deceased with suspected coronavirus infection (COVID-19): Interim guidelines]. M., 2020. 428 p.

6. Savchenko S.V., Nadeev A.P., Gricinger V.A., Tihonov V.V. Ekspertnaya otsenka kliniko-morfologicheskikh izmeneniy v sluchayakh smerti, svyazannykh s COVID-19. Metodicheskoye posobiye [Expert assessment of clinical and morphological changes in deaths associated with COVID-19. Study guide]. Novosibirsk: Sibmedizdat Publ., 2020. 80 p.

7. Hirmanov V.N. COVID 19 kak sistemnoye zabolevaniye. Klinicheskaya farmakologiya i terapiya [COVID 19 as a systemic disease. Clinical Pharmacology and Therapy]. Available at: https://clinpharm-journal.ru/articles/20211/covid-19-kak-sistemnoe-zabolevanie. (accessed 05.03.2022)

8. Savchenko S.V., Gritsinger V.A., Tikhonov V.V., Lamanov A.N., Novoselov V.P., Koshlyak D.A. Klinikoanatomicheskiy analiz letal'nosti ot COVID-19 pri skoropostizhnoy smerti i u umershikh v lechebnoprofilakticheskikh uchrezhdeniyakh [Clinical and anatomical analysis of mortality from COVID-19 in sudden death and in those who died in health care facilities]. Sudebno-meditsinskaya ekspertiza — Forensic Medical Examination, 2021, vol. 64(3), pp. 5–10. doi: https://doi.org/10.17116/sudmed2021640315

9. Donchenko E.V. Kompensatornyye eritrotsitozy pri-china TELA, infarktov, insul'tov v praktike ekolo-gicheskoy meditsiny [Compensatory erythrocytosis causing pulmonary embolism, heart attacks, strokes in the practice of environmental medicine]. VIII Mezhdunarodnyy congress «Slabyye i sverkhslabyye polya i izlucheniya v biologii i meditsine». Nauchnyye trudy Kongressa [III International Congress "Weak and Superweak Fields and Radiation in Biology and Medicine". Scientific proceedings of the Congress]. St. Petersburg, 2018, pp. 169–170.

10. Damage to the nervous system with COVID-19. Available at: https://medach.pro/post/2342 (In Russ.)