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Tracking the time course of pathological patterns of lung injury in severe COVID-19.
Mauad, Thais; Duarte-Neto, Amaro Nunes; da Silva, Luiz Fernando Ferraz; de Oliveira, Ellen Pierre; de Brito, Jose Mara; do Nascimento, Ellen Caroline Toledo; de Almeida Monteiro, Renata Aparecida; Ferreira, Juliana Carvalho; de Carvalho, Carlos Roberto Ribeiro; do Nascimento Saldiva, Paulo Hilário; Dolhnikoff, Marisa.
  • Mauad T; Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Cerqueira Cesar, São Paulo, Brazil. tmauad@usp.br.
  • Duarte-Neto AN; Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Cerqueira Cesar, São Paulo, Brazil.
  • da Silva LFF; Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Cerqueira Cesar, São Paulo, Brazil.
  • de Oliveira EP; Serviço de Verificação de Óbitos da Capital, Universidade de São Paulo, São Paulo, Brazil.
  • de Brito JM; Departamento de Cardiopneumologia, Instituto Do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
  • do Nascimento ECT; Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Cerqueira Cesar, São Paulo, Brazil.
  • de Almeida Monteiro RA; Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Cerqueira Cesar, São Paulo, Brazil.
  • Ferreira JC; Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Cerqueira Cesar, São Paulo, Brazil.
  • de Carvalho CRR; Departamento de Cardiopneumologia, Instituto Do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
  • do Nascimento Saldiva PH; Departamento de Cardiopneumologia, Instituto Do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
  • Dolhnikoff M; Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Cerqueira Cesar, São Paulo, Brazil.
Respir Res ; 22(1): 32, 2021 Jan 29.
Article in English | MEDLINE | ID: covidwho-1054820
ABSTRACT

BACKGROUND:

Pulmonary involvement in COVID-19 is characterized pathologically by diffuse alveolar damage (DAD) and thrombosis, leading to the clinical picture of Acute Respiratory Distress Syndrome. The direct action of SARS-CoV-2 in lung cells and the dysregulated immuno-coagulative pathways activated in ARDS influence pulmonary involvement in severe COVID, that might be modulated by disease duration and individual factors. In this study we assessed the proportions of different lung pathology patterns in severe COVID-19 patients along the disease evolution and individual characteristics.

METHODS:

We analysed lung tissue from 41 COVID-19 patients that died in the period March-June 2020 and were submitted to a minimally invasive autopsy. Eight pulmonary regions were sampled. Pulmonary pathologists analysed the H&E stained slides, performing semiquantitative scores on the following parameters exudative, intermediate or advanced DAD, bronchopneumonia, alveolar haemorrhage, infarct (%), arteriolar (number) or capillary thrombosis (yes/no). Histopathological data were correlated with demographic-clinical variables and periods of symptoms-hospital stay.

RESULTS:

Patient´s age varied from 22 to 88 years (18f/23 m), with hospital admission varying from 0 to 40 days. All patients had different proportions of DAD in their biopsies. Ninety percent of the patients presented pulmonary microthrombosis. The proportion of exudative DAD was higher in the period 0-8 days of hospital admission till death, whereas advanced DAD was higher after 17 days of hospital admission. In the group of patients that died within eight days of hospital admission, elderly patients had less proportion of the exudative pattern and increased proportions of the intermediate patterns. Obese patients had lower proportion of advanced DAD pattern in their biopsies, and lower than patients with overweight. Clustering analysis showed that patterns of vascular lesions (microthrombosis, infarction) clustered together, but not the other patterns. The vascular pattern was not influenced by demographic or clinical parameters, including time of disease progression.

CONCLUSION:

Patients with severe COVID-19 present different proportions of DAD patterns over time, with advanced DAD being more prevalent after 17 days, which seems to be influenced by age and weight. Vascular involvement is present in a large proportion of patients, occurs early in disease progression, and does not change over time.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Lung Injury / COVID-19 / Lung Type of study: Observational study / Prognostic study Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged / Young adult Language: English Journal: Respir Res Year: 2021 Document Type: Article Affiliation country: S12931-021-01628-9

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Lung Injury / COVID-19 / Lung Type of study: Observational study / Prognostic study Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged / Young adult Language: English Journal: Respir Res Year: 2021 Document Type: Article Affiliation country: S12931-021-01628-9