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Classified by the date of death, 21 cases were from the pandemic\u2019s \u201cfirst wave\u201d (March through July) and 79 from the \u201csecond wave\u201d (August through December). Three mortality categories were defined by relevance of SARS-CoV-2 infection: (1) \u201cstrong\u201d association (<jats:italic>n<\/jats:italic>=57), in which COVID-19 was primary responsible for death; (2) \u201ccontributive\u201d association (<jats:italic>n<\/jats:italic>=27), in which a pre-existing condition independent of COVID-19 was primary responsible for death, albeit with substantial COVID-19 co-morbidity; (3) \u201cweak\u201d association (<jats:italic>n<\/jats:italic>=16), in which COVID-19 was minimally or not at all responsible for death. Distributions among categories differed between the first wave, in which the \u201ccontributive\u201d association cases dominated (strong: 24%, contributive: <jats:italic>48%<\/jats:italic>, weak: 28%), and the second wave, in which the \u201cstrong\u201d association cases dominated (strong: <jats:italic>66%<\/jats:italic>, contributive: 21%, weak: 13%). Charted co-morbidities included hypertension (85 %), cardiovascular diseases (71 %), diabetes (40 %), cerebrovascular diseases (31 %), chronic respiratory diseases (30 %), malignant tumors (20 %), renal diseases (19 %), diseases of the central nervous system (15 %), and liver diseases (6 %). Autopsy evaluation analyzed alterations on macroscopy as well as findings on microscopy of scanned and scored sections of formalin-fixed, paraffin-embedded tissue samples (50\u201380 blocks\/case). Severity of histological abnormalities in the lung differed significantly between \u201cstrong\u201d and \u201ccontributive\u201d (<jats:italic>p<\/jats:italic>&lt;0.0001) and between \u201cstrong\u201d and \u201cweak\u201d categories (<jats:italic>p<\/jats:italic>&lt;0.0001). Abnormalities included diffuse alveolar damage, macrophage infiltration, and vascular and alveolar fibrin aggregates (lung), with macro- and microvascular thrombi and thromboemboli (lung, kidney, liver). In conclusion, autopsies clarified in what extent COVID-19 was responsible for death, demonstrated the pathological background of clinical signs and symptoms, and identified organ alterations that led to the death. Clinicopathologic correlation, with conference discussions of severity of co-morbidities and of direct pathological signs of disease, permitted accurate categorization of cause of death and COVID-19 association as \u201cstrong,\u201d \u201ccontributive,\u201d or \u201cweak.\u201d Lung involvement, with reduced ventilatory capacity, was the primary cause of death in the \u201cstrong\u201d and \u201ccontributive\u201d categories. Shifts in distribution among categories, with \u201cstrong\u201d association between COVID-19 and death dominating in the second wave, may reflect improved clinical management of COVID-19 as expertise grew.<\/jats:p>","DOI":"10.1007\/s11357-021-00451-w","type":"journal-article","created":{"date-parts":[[2021,9,12]],"date-time":"2021-09-12T12:04:13Z","timestamp":1631448253000},"page":"2265-2287","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["A COVID-19-association-dependent categorization of death causes in 100 autopsy cases"],"prefix":"10.1007","volume":"43","author":[{"given":"Krisztina","family":"Danics","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adri\u00e1n","family":"Pesti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kl\u00e1ra","family":"T\u00f6r\u0151","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"No\u00e9mi","family":"Kiss-Dala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00e1nos","family":"Szl\u00e1vik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Botond","family":"Lakatos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Radnai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tam\u00e1s","family":"Bal\u00e1zs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikl\u00f3s","family":"Bacskai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dej\u00e1n","family":"Dobi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tibor","family":"V\u00e1rkonyi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tibor","family":"Glasz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00e1bor","family":"Lotz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e1s","family":"Kiss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6429-8059","authenticated-orcid":false,"given":"Zsuzsa","family":"Schaff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Istv\u00e1n","family":"V\u00e1lyi-Nagy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,9,11]]},"reference":[{"issue":"8","key":"451_CR1","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1056\/NEJMoa2001017","volume":"382","author":"N Zhu","year":"2020","unstructured":"Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. 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