Acute respiratory distress syndrome in CoViD-19: correlations between clinical and histopathologic patterns

ABSTRACT

Background and Aim: We conducted a multidisciplinary study to investigate the correlations between clinical-laboratory-imaging data and histopathologic pulmonary patterns in patients died from severe CoViD-19. Materials and Methods: We analyzed lung autoptic tissue from consecutive CoViD-19 patients between February 29 and June 30, 2020. We considered three samples for each pulmonary lobe per patient. The pre-specified histopathological patterns were exudative diffuse alveolar damage (DAD), proliferative DAD, organizing pneumonia, acute fibrinous organizing pneumonia, interstitial pneumonia, bronchopneumonia, arteriolar thrombi, intracapillary megakaryocytes, and areas of normal lung. Hierarchical cluster analysis was performed. Results: Among 92 autopsies, 48 patients had complete clinical data. Four clusters were identified. Length-of-stay in ICU and in hospital (p<0.0001), days on mechanical ventilation (p<0.0001), days on positive pressure airway (p<0.0001), mean positive endexpiratory pressure PEEP (p=0.007), PEEP x days on mechanical ventilation (p=0.003), PEEP x days on positive pressure airway (p=0.003), worst serum albumin (p=0.017), interleukin 6 (p=0.047), and kidney SOFA (p=0.001) differed between clusters. The cluster characterized by prevalence of exudative-proliferative DAD and lung megakaryocytosis had the greater difference from the others. Conclusions: Our research sheds light on the correlations between clinical-laboratory-imaging pictures and histopathologic findings, with clues on the impact of therapeutic strategies on lung tissues.