Histopathological features in fatal COVID-19 acute respiratory distress syndrome.
Aged
B-Lymphocytes
Biopsy
COVID-19
/ complications
Female
Humans
Lung
/ pathology
Male
Middle Aged
Prospective Studies
Respiration, Artificial
/ statistics & numerical data
Respiratory Distress Syndrome
/ etiology
SARS-CoV-2
/ isolation & purification
T-Lymphocytes
Tertiary Care Centers
Time Factors
COVID-19
COVID-19 related acute respiratory distress syndrome
Histopathology
Histopatología
SARS-CoV-2
Síndrome de dificultad respiratoria aguda asociada a COVID-19
Journal
Medicina intensiva
ISSN: 2173-5727
Titre abrégé: Med Intensiva (Engl Ed)
Pays: Spain
ID NLM: 101717568
Informations de publication
Date de publication:
Historique:
received:
01
01
2021
accepted:
05
02
2021
entrez:
1
6
2021
pubmed:
2
6
2021
medline:
11
6
2021
Statut:
ppublish
Résumé
COVID-19 acute respiratory distress syndrome (ARDS) shares the common histological hallmarks with other forms of ARDS. However, the chronology of the histological lesions has not been well established. To describe the chronological histopathological alterations in the lungs of patients with COVID-19 related ARDS. A prospective cohort study was carried out. Intensive Care Unit of a tertiary hospital. The first 22 consecutive COVID-19 deaths. Lung biopsies and histopathological analyses were performed in deceased patients with COVID-19 related ARDS. Clinical data and patient course were evaluated. The median patient age was 66 [63-74] years; 73% were males. The median duration of mechanical ventilation was 17 [8-24] days. COVID-19 induced pulmonary injury was characterized by an exudative phase in the first week of the disease, followed by a proliferative/organizing phase in the second and third weeks, and finally an end-stage fibrosis phase after the third week. Viral RNA and proteins were detected in pneumocytes and macrophages in a very early stage of the disease, and were no longer detected after the second week. Limited sample size. The chronological evolution of COVID-19 lung histopathological lesions seems to be similar to that seen in other forms of ARDS. In particular, lung lesions consistent with potentially corticosteroid-sensitive lesions are seen.
Sections du résumé
BACKGROUND
COVID-19 acute respiratory distress syndrome (ARDS) shares the common histological hallmarks with other forms of ARDS. However, the chronology of the histological lesions has not been well established.
OBJECTIVE
To describe the chronological histopathological alterations in the lungs of patients with COVID-19 related ARDS.
DESIGN
A prospective cohort study was carried out.
SETTING
Intensive Care Unit of a tertiary hospital.
PATIENTS
The first 22 consecutive COVID-19 deaths.
MEASUREMENTS
Lung biopsies and histopathological analyses were performed in deceased patients with COVID-19 related ARDS. Clinical data and patient course were evaluated.
RESULTS
The median patient age was 66 [63-74] years; 73% were males. The median duration of mechanical ventilation was 17 [8-24] days. COVID-19 induced pulmonary injury was characterized by an exudative phase in the first week of the disease, followed by a proliferative/organizing phase in the second and third weeks, and finally an end-stage fibrosis phase after the third week. Viral RNA and proteins were detected in pneumocytes and macrophages in a very early stage of the disease, and were no longer detected after the second week.
LIMITATION
Limited sample size.
CONCLUSIONS
The chronological evolution of COVID-19 lung histopathological lesions seems to be similar to that seen in other forms of ARDS. In particular, lung lesions consistent with potentially corticosteroid-sensitive lesions are seen.
Identifiants
pubmed: 34059216
pii: S2173-5727(21)00061-8
doi: 10.1016/j.medine.2021.02.005
pmc: PMC8161799
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
261-270Informations de copyright
Copyright © 2021 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.
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