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Vol. 45. Issue 5.
Pages 261-270 (June - July 2021)
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Vol. 45. Issue 5.
Pages 261-270 (June - July 2021)
Original article
DOI: 10.1016/j.medine.2021.02.005
Histopathological features in fatal COVID-19 acute respiratory distress syndrome
Características hispotatológicas en el síndrome de dificultad respiratoria aguda asociado a COVID-19 mortal
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H. Merdjia,b, S. Mayeurc, M. Schenckd, W. Oulehrie,f, R. Clere-Jehla,g, S. Cunata, J.-E. Herbrechtd, R. Janssen-Langensteind, A. Nicolaec, J. Helmsa,g, F. Meziania,b,
Corresponding author
, M.-P. Chenardc,h, for the CRICS TRIGGERSEP Group (Clinical Research in Intensive Care, Sepsis Trial Group for Global Evaluation, Research in Sepsis)
a Service de Médecine Intensive - Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
b INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
c Département de Pathologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
d Service de Médecine Intensive - Réanimation, Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
e Service d’Anesthésie - Réanimation Chirurgicale, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
f Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), Strasbourg, France
g ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, LabEx TRANSPLANTEX, Centre de Recherche d’Immunologie et d’Hématologie, Faculté de Médecine, Fédération Hospitalo-Universitaire (FHU) OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), Strasbourg, France
h Centre de Ressources biologiques, Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Figures (4)
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Tables (6)
Table 1. Baseline characteristics of the 22 patients.
Table 2. Ventilatory parameters at admission and at time of death.
Table 3. Characteristics of 22 patients with or without fibrosis at histological examination.
Table 4. Histologic features of 22 patients who received steroids or not.
Table 5. Histologic features of 22 patients who developed a ventilator-associated pneumonia (VAP) and those who did not.
Table 6. Characteristics of 22 patients with or without acute fibrinous and organizing pneumonia (AFOP) at histological examination.
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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.

Keywords:
COVID-19
SARS-CoV-2
COVID-19 related acute respiratory distress syndrome
Histopathology
Abbreviations:
COVID-19
ACE2
ARDS
VILI
HE
DAD
AFOP
ISH
SAPSII
SOFA
NMBD
RT-PCR
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.

Palabras clave:
COVID-19
SARS-CoV-2
Síndrome de dificultad respiratoria aguda asociada a COVID-19
Histopatología

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