Lung histopathologic clusters in severe COVID-19: a link between clinical picture and tissue damage

Critical Care

Davide Ottolina¹  Antonio Castelli¹  Roberto Rech¹  Tommaso Fossali¹  Riccardo Colombo¹  Emanuele Catena¹  Jonathan Montomoli²  Maddalena Alessandra Wu³  Chiara Cogliati⁴  Luca Carsana⁵  Manuela Nebuloni⁶  Gianluca Lopez⁷ 

[1] Division of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Milan, Italy;Division of Anesthesiology and Intensive Care, Ospedale Degli Infermi, Rimini, Italy;Division of Internal Medicine, ASST Fatebenefratelli Sacco, Milan, Italy;Division of Internal Medicine, ASST Fatebenefratelli Sacco, Milan, Italy;Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy;Pathology Unit, ASST Fatebenefratelli Sacco, Milan, Italy;Pathology Unit, ASST Fatebenefratelli Sacco, Milan, Italy;Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy;School of Pathology, University of Milan, Milan, Italy;Pathology Unit, ASST Fatebenefratelli Sacco, Milan, Italy;

关键词: COVID-19;    Lung injury;    Positive-pressure ventilation;    Histology;    Pneumonia;   

DOI  :  10.1186/s13054-021-03846-5

来源: Springer

【 摘 要 】

BackgroundAutoptic pulmonary findings have been described in severe COVID-19 patients, but evidence regarding the correlation between clinical picture and lung histopathologic patterns is still weak.MethodsThis was a retrospective cohort observational study conducted at the referral center for infectious diseases in northern Italy. Full lung autoptic findings and clinical data of patients who died from COVID-19 were analyzed. Lung histopathologic patterns were scored according to the extent of tissue damage. To consider coexisting histopathologic patterns, hierarchical clustering of histopathologic findings was applied.ResultsWhole pulmonary examination was available in 75 out of 92 full autopsies. Forty-eight hospitalized patients (64%), 44 from ICU and four from the medical ward, had complete clinical data. The histopathologic patterns had a time-dependent distribution with considerable overlap among patterns. Duration of positive-pressure ventilation (p < 0.0001), mean positive end-expiratory pressure (PEEP) (p = 0.007), worst serum albumin (p = 0.017), interleukin 6 (p = 0.047), and kidney SOFA (p = 0.001) differed among histopathologic clusters. The amount of PEEP for long-lasting ventilatory treatment was associated with the cluster showing the largest areas of early and late proliferative diffuse alveolar damage. No pharmacologic interventions or comorbidities affected the lung histopathology.ConclusionsOur study draws a comprehensive link between the clinical and pulmonary histopathologic findings in a large cohort of COVID-19 patients. These results highlight that the positive end-expiratory pressures and the duration of the ventilatory treatment correlate with lung histopathologic patterns, providing new clues to the knowledge of the pathophysiology of severe SARS-CoV-2 pneumonia.

【 授权许可】

CC BY