Histopathological features in fatal COVID-19 acute respiratory distress syndrome.
Med Intensiva (Engl Ed)
; 45(5): 261-270, 2021.
Article
in English
| MEDLINE | ID: covidwho-1104158
ABSTRACT
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.RESUMEN
Antecedentes El síndrome de dificultad respiratoria aguda (SDRA) asociado a la COVID-19 comparte características histológicas con otros tipos de SDRA. Sin embargo, no se ha establecido adecuadamente la cronología de las lesiones histológicas. Objetivo:
Describir las alteraciones histopatológicas cronológicas en los pulmones de los pacientes con síndrome de dificultad respiratoria aguda asociado a COVID-19.Diseño:
Estudio prospectivo de cohortes. Ámbito Unidad de cuidados intensivos de un hospital terciario. Pacientes Las primeras 22 muertes consecutivas por COVID-19. Intervenciones Se llevaron a cabo biopsias pulmonares y análisis histopatológicos en pacientes fallecidos por SDRA asociado a COVID-19. Se evaluaron los datos clínicos y la evolución médica.Resultados:
La mediana de edad de los pacientes fue de 66 (63-74) años y el 73% eran varones. La mediana de la duración de la ventilación mecánica fue de 17 (8-24) días. La lesión pulmonar inducida por COVID-19 se caracterizó por una fase exudativa durante la primera semana de la enfermedad, seguida de una fase proliferativa/organizativa en la segunda y tercera semana y, por último, una fase de fibrosis en fase terminal tras la tercera semana de evolución. Se detectaron proteínas y ARN vírico en neumocitos y macrófagos en una fase muy temprana de la enfermedad, pero estos ya no se volvieron a detectar a partir de la segunda semana. Limitación Tamaño limitado de la muestra.Conclusión:
La evolución cronológica de las lesiones histopatológicas pulmonares asociadas a la COVID-19 parece ser similar a la de otras formas de SDRA. En particular, se observan daños pulmonares coherentes con las lesiones potencialmente sensibles a los corticosteroides.
ACE2, angiotensin-converting enzyme 2; AFOP, acute fibrinous and organizing pneumonia; ARDS, acute respiratory distress syndrome; COVID-19; COVID-19 related acute respiratory distress syndrome; COVID-19, coronavirus infectious disease; DAD, diffuse alveolar damage; HE, hematoxylineosin; Histopathology; ISH, in situ hybridization; NMBD, neuromuscular blocking drugs; RT-PCR, Reverse Transcriptase-Polymerase chain reaction; SAPSII, simplified acute physiology score; SARS-CoV-2; SOFA, Sequential Organ Failure Assessment; VILI, ventilator induced lung injury
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Type of study:
Cohort study
/
Diagnostic study
/
Experimental Studies
/
Observational study
/
Prognostic study
Language:
English
Journal:
Med Intensiva (Engl Ed)
Year:
2021
Document Type:
Article
Affiliation country:
J.medin.2021.02.007
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