Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2018, vol. 27, nr 1, January, p. 63–70

doi: 10.17219/acem/65866

Publication type: original article

Language: English

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Heart infarct as the major cause of death of hematological patients as identified by autopsy

Anna Waszczuk-Gajda1,B,C,D,E,F, Michał F. Kamiński1,2,B,C,D, Łukasz Koperski3,E, Anna Kamińska1,4,B,C, Joanna Drozd-Sokołowska1,B,C, Zbigniew Lewandowski5,C, Aleksander Wasiutyński6,F, Barbara Górnicka3,F, Wiesław W. Jędrzejczak1,A,E,F

1 Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Poland

2 Department of Gastroenterology, Hepatology and Oncology, Medical Centre for Postgraduate Education, The Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warszawa, Poland

3 Department of Pathology, Medical University of Warsaw, Poland

4 II Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland

5 Department of Epidemiology and Biostatistics, Medical University of Warsaw, Poland

6 Department of Pathomorphology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warszawa, Poland

Abstract

Background. Despite progress in diagnostic procedures, clinical diagnosis is not always confirmed by an autopsy. An autopsy is a valuable tool in evaluating diagnostic accuracy.
Objectives. The aim of the study was to compare clinical diagnoses of immediate causes of death with autopsy findings in patients with hematological malignancies or aplastic anemia.
Material and Methods. In this study, the results of 154 autopsies (1993–2004) of patients with hematological diseases were reviewed and compared with clinical data. The most probable causes of death in the case of particular hematological diseases as well as the discordances between clinical and autopsy diagnoses and their relation to the clinical characteristic were identified in the studied cohort, which primarily included patients whose death at that particular time was not explained by the clinical course, and in 50% of cases was sudden.
Results. Although various combined infections have been found to be responsible for the largest number of deaths (26.6%), the most common single cause was myocardial infarction (29 patients, 18.8%). The discordance between clinical and post-mortem diagnoses of immediate causes of death was found in 55 patients (35.7%; 95% CI 28.2–42.8%), with 50.9% of cases considered class I discrepancies according to Goldman’s criteria. The myocardial infarction was found to be clinically undiagnosed in 69% of cases. In 41% of cases, it was a class I discrepant diagnosis.
Conclusion. This data suggests that hematological patients require special attention and probably preventive measures concerning coronary heart disease, particularly during the initiation of antineoplastic therapy.

Key words

hematology, malignancies, cause of death, discordance, autopsy

References (30)

  1. Avgerinos DV, Bjornsson J. Malignant neoplasms: Discordance between clinical diagnoses and autopsy findings in 3,118 cases. APMIS. 2001;109:774–780.
  2. Tavora F, Crowder CD, Sun CC, Burke AP. Discrepancies between clinical and autopsy diagnoses: A comparison of university, community, and private autopsy practices. Am J Clin Pathol. 2008;129(1):102–109.
  3. Ayoub T, Chow J. The conventional autopsy in modern medicine. J R Soc Med. 2008;101(4):177–181.
  4. Burton EC, Troxclair DA, Newman WP 3rd. Autopsy diagnoses of malignant neoplasms: How often are clinical diagnoses incorrect? JAMA. 1998;280:1245–1248.
  5. Goldman L, Sayson R, Robbins S, Cohn LH, Bettmann M, Weisberg M. The value of the autopsy in three medical eras. N Engl J Med. 1983;308:1000–1005.
  6. Sinard JH. Factors affecting autopsy rates, autopsy request rates, and autopsy findings at a large academic medical center. Exp Mol Pathol. 2001;70(3):333–343.
  7. Gerain J, Sculier JP, Malengreaux A, Rykaert C, Themelin L. Causes of deaths in an oncologic intensive care unit: A clinical and pathological study of 34 autopsies. Eur J Cancer. 1990;26:377–381.
  8. Provencio M, Espana P, Salas C, Navarro F, Bonilla F. Hodgkin’s disease: Correlation between causes of death at autopsy and clinical diagnosis. Ann Oncol. 2000;11;59–64.
  9. Singh H, Sethi S, Raber M, Petersen LA. Errors in cancer diagnosis: Current understanding and future directions. J Clin Oncol. 2007;25(31):5009–5018.
  10. Pritt BS, Hardin NJ, Richmond JA, Shapiro SL. Death certification errors at an academic institution. Arch Pathol Lab Med. 2005;129(11):1476–1479.
  11. Shojania KG, Burton EC, McDonald KM, Goldman L. Changes in rates of autopsy-detected diagnostic errors over time: A systematic review. JAMA. 2003;289:2849–2856.
  12. Soracci R. Autopsy as the yardstick for diagnosis: An epidemiologist’s remark. IARC Sci Publ. 1991;(112):185–196.
  13. Donhuijsen K, Pfaffenbach B, Samandari S, Leder LD. Autopsy results of deep mycoses in hematologic neoplasms (1053 patients). Mycoses. 1991;34(Suppl1):25–27.
  14. Xavier ACG, Siqueira SAC, Costa LJM, Mauad T, Nascimento Saldiva PH. Missed diagnosis in hematological patients: An autopsy study. Virchows Arch. 2004;446:225–31.
  15. Saviola A, Luppi M, Potenza L, et al. Myocardial ischemia in a patient with acute lymphoblastic leukemia during L-asparaginase therapy. Eur J Haematol. 2004;72(1):71–72.
  16. Tai DYH, El-Bilbeisi H, Tewari S, Mascha EJ, Wiedemann HP, Arroliga AC. A study of consecutive autopsies in a medical ICU. Chest. 2001;119:530–536.
  17. Manci AE, Culberson DE, Yih-Ming Yang, et al. Causes of death in sickle cell disease: An autopsy study. BJH. 2003;123:359–365.
  18. Nosari A, Barberis M, Landonio G, et al. Infections in haematologic neoplasms: Autopsy findings. Haematologica. 1991;76(2):135–140.
  19. Assiri AH, Lamba M, Veinot JP. Chronic lymphocytic leukemia involving the coronary arteries with accompanying acute myocardial infarction. Cardiovasc Pathol. 2005;14(6):324–326.
  20. López-Miranda V, Herradón E, González C, Martín MI. Vascular toxicity of chemotherapeutic agents. Curr Vasc Pharmacol. 2010;8(5):692–700.
  21. Plana JC, Galderisi M, Barac A, et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: A report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2014;15(10):1063–1093.
  22. Volkova M, Russell R. Anthracycline cardiotoxicity: Prevalence, pathogenesis and treatment. Curr Cardiol Rev. 2011;7(4):214–220.
  23. Kuijpers CC, Fronczek J, van de Goot FR, Niessen HW, van Diest PJ, Jiwa M. The value of autopsies in the era of high-tech medicine: Discrepant findings persist. J Clin Pathol. 2014;67(6):512–519.
  24. Ioan B, Alexa T, Alexa ID. Do we still need the autopsy? Clinical diagnosis versus autopsy diagnosis. Rom J Leg Med. 2012;20:307–312.
  25. Maris C, Martin B, Creteur J, et al. Comparison of clinical and post-mortem findings in intensive care unit patients. Virchows Arch. 2007;450(3):329–333.
  26. Stevanovic G, Tucakovic G, Dotlic R, Kanjuh V. Correlation of clinical diagnoses with autopsy findings: A retrospective study of 2,145 consecutive autopsies. Hum Pathol. 1986;17(12):1225–1230.
  27. Hofmeister CC, Marinier DE, Czerlanis C, Stiff PJ. Clinical utility of autopsy after hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2007;13(1):26–30.
  28. Spiliopoulou C, Papadodima S, Kotakidis N, Koutselinis A. Clinical diagnoses and autopsy findings: A retrospective analysis of 252 cases in Greece. Arch Pathol Lab Med. 2005;129(2):210–214.
  29. Dimopoulos G, Piagnerelli M, Berré J, Salmon I, Vincent JL. Post mortem examination in the intensive care unit: Still useful? Intensive Care Med. 2004;30(11):2080–2085.
  30. Perkins GD, McAuley DF, Davies S, Gao F. Discrepancies between clinical and postmortem diagnoses in critically ill patients: An observational study. Crit Care. 2003;7:R129–R132.