Medicina intensiva · 2021
Histopathological features in fatal COVID-19 acute respiratory distress syndrome.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Merdji H, Mayeur S, Schenck M, Oulehri W, Clere-Jehl R, Cunat S, Herbrecht J-E, Janssen-Langenstein R, Nicolae A, Helms J, Meziani F, Chenard M-P, CRICS TRIGGERSEP Group (Clinical Research in Intensive Care, Sepsis Trial Group for Global Evaluation, Research in Sepsis)
Аннотация
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.
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.