Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Apr 21;15(1):13728.
doi: 10.1038/s41598-025-98834-y.

Deaths "due to" COVID-19 and deaths "with" COVID-19 during the Omicron variant surge, among hospitalized patients in seven tertiary-care hospitals, Athens, Greece

Dimitrios Basoulis  1 , Krystalenia Logioti  2 , Ioanna Papaodyssea  3 , Marios Chatzopoulos  4 , Panagiota Alexopoulou  5 , Panagiotis Mavroudis  6 , Vassiliki Rapti  7 , Vassiliki Poulia  2 , Stamatina Samara  8 , Vassiliki E Georgakopoulou  8 , Maria N Gamaletsou  8   9 , Christos Michailidis  4 , Garyfallia Poulakou  7   9 , Theano Kontopoulou  3 , Vasileios Papastamopoulos  3 , Georgios Chrysos  6 , Maria Chini  2 , Anastasia Antoniadou  5   9 , Nikolaos V Sipsas  10   11
Affiliations

Deaths "due to" COVID-19 and deaths "with" COVID-19 during the Omicron variant surge, among hospitalized patients in seven tertiary-care hospitals, Athens, Greece

Dimitrios Basoulis et al. Sci Rep. .

Abstract

In Greek hospitals, all deaths with a positive SARS-CoV-2 test are counted as COVID-19 deaths. Our aim was to investigate whether COVID-19 was the primary cause of death, a contributing cause of death or not-related to death amongst patients who died in hospitals during the Omicron surge and were registered as COVID-19 deaths. Additionally, we aimed to analyze the factors associated with the classification of these deaths. We retrospectively re-viewed all in-hospital deaths, that were reported as COVID-19 deaths, in 7 hospitals, serving Athens, Greece, from January 1, 2022, until August 31, 2022. We retrieved clinical and laboratory data from patient records. Each death reported as COVID-19 death was characterized as: (A) death "due to" COVID-19, or (B) death "with" COVID-19. We reviewed 530 in-hospital deaths, classified as COVID-19 deaths (52.4% males; mean age 81.7 ± 11.1 years). We categorized 290 (54.7%) deaths as attributable or related to COVID-19 and in 240 (45.3%) deaths unrelated to COVID-19 In multivariable analysis The two groups differed significantly in age (83.6 ± 9.8 vs. 79.9 ± 11.8, p = 0.016), immunosuppression history (11% vs. 18.8%, p = 0.027), history of liver disease (1.4% vs. 8.4%, p = 0.047) and the presence of COVID-19 symptoms (p < 0.001). Hospital stay was greater in persons dying from non-COVID-19 related causes. Among 530 in-hospital deaths, registered as COVID-19 deaths, in seven hospitals in Athens during the Omicron wave, 240 (45.28%) were reassessed as not directly attributable to COVID-19. Accuracy in defining the cause of death during the COVID-19 pandemic is of paramount importance for surveillance and intervention purposes.

Keywords: COVID-19; Cause of death; Death certificates; Greece; Hospital mortality.

PubMed Disclaimer

Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethical approval: This study has received ethical approval from the Ethical Review Boards of participating hospitals, i.e. the Laiko General Hospital Scientific and Ethics Review Board, the Red Cross General Hospital Scientific and Ethics Review Board, the Evaggelismos General Hospital Scientific and Ethics Review Board, the Georgios Gennimatas General Hospital Scientific and Ethics Review Board, the Attikon General Hospital Scientific and Ethics Review Board, the Tzaneio General Hospital Scientific and Ethics Review Board and the Sotiria Chest Disease Hospital Scientific and Ethics Review Board. Informed consent was waived as the data was anonymized when included in the database for analysis and no risk or harm would come to participants.

References

    1. Pan, D., Nishimura, H. & Tang, J. W. Information bias for case definitions and mortality between and within studies over time undermines our understanding of COVID-19 transmission and disease severity. Clin. Microbiol. Infect.30(6), 700–702. 10.1016/j.cmi.2024.02.002 (2024). - PubMed
    1. Surveillance definitions for COVID-19. ECDC. [Online] [Cited: January 22, 2023.] https://www.ecdc.europa.eu/en/covid-19/surveillance/surveillance-definit...
    1. Paglino, E. et al. Differences between reported COVID-19 deaths and estimated excess deaths in counties across the united States, March 2020 to February 2022. medRxiv 10.1101/2023.01.16.23284633
    1. Statens Serum Institutation. Surveillance of mortality related to the COVID-19 epidemic in Denmark. Memo from the SSI on the surveillance methods applied and the interpretation of collected data. [Online] February 17, 2022. [Cited: September 15, 2024.] https://www.ssi.dk/sygdomme-beredskab-og-forskning/sygdomsovervaagning/d...
    1. Slater, T. A. et al. Dying ‘due to’ or ‘with’ COVID-19: A cause of death analysis in hospitalised patients. Clin. Med. (Lond). 20(5), e189–e190. 10.7861/clinmed.2020-0440 (2020). - PMC - PubMed

Supplementary concepts