Clinicopathological Analysis of Fatal Cases Involving Covid-19, Type 2 Diabetes Mellitus, and Their Combination

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has gained particular clinical significance in patients with type 2 diabetes mellitus (T2DM), which is recognized as an independent risk factor for a severe course of the infection. The coexistence of COVID-19 and T2DM exacerbates multiorgan damage and significantly increases the risk of mortality.Objective. To conduct a comparative clinicopathological analysis of complications, comorbidities, and immediate causes of death in individuals with COVID-19, T2DM, and their combination.Material and Methods. A total of 120 protocols of pathological examinations of deceased patients were analyzed and categorized into three groups: I – COVID-19 in combination with DM2, II – COVID-19, III – DM2. An analysis of complications, comorbidities, and immediate causes of death was conducted using Pearson’s chi-square test and binary logistic regression.Results. Analysis of complications revealed that patients in Group I exhibited the highest incidence of hemorrhagic pneumonia (90.0%), respiratory failure (100.0%), and renal tubular epithelial necrosis (97.5%). In patients with isolated COVID-19, cardiovascular complications predominated, with cardiovascular failure observed in 45.0% of cases. In contrast, patients with T2DM without concomitant infection predominantly exhibited hepatocellular failure (25.0%), septicemia (25.0%), multiorgan failure (22.5%), and cerebral failure (30.0%). Regarding comorbidities, ischemic heart disease (IHD) was the most common pathology among all studied patients, with the highest frequency observed in the group with comorbidities (77.5%). Analysis of immediate causes of death revealed that respiratory failure was predominant in the COVID-19-related groups (52.5% in COVID-19, 32.0% in COVID-19+T2DM). In patients with isolated T2DM, the most common causes of death were multiple organ failure (50.0%) and brain failure (17.5%).Conclusions. The structure of complications, comorbidities and causes of death differs significantly depending on the variant of the combination of COVID-19 and T2DM. Comorbid pathology results in the most severe clinical and morphological outcomes, characterized by extensive damage to the lungs, kidneys, and liver, as well as a high frequency of background cardiovascular disorders. The data obtained underscore the importance of early detection and active monitoring of these complications, particularly in individuals with metabolic disorders who are infected with SARS-CoV-2.