Abstract in English, Spanish
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.
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.
Keywords: COVID-19; COVID-19 related acute respiratory distress syndrome; Histopathology; Histopatología; SARS-CoV-2; Síndrome de dificultad respiratoria aguda asociada a COVID-19.
【저자키워드】 COVID-19, SARS-CoV-2, Histopathology, COVID-19 related acute respiratory distress syndrome, Histopatología, Síndrome de dificultad respiratoria aguda asociada a COVID-19., 【초록키워드】 Evolution, Macrophage, Respiratory distress syndrome, ARDS, macrophages, acute respiratory distress syndrome, mechanical ventilation, Corticosteroides, hospital, intensive care unit, lung, fibrosis, prospective cohort study, Histopathology, RNA, Protein, clinical, Lungs, Patient, age, Viral RNA, pulmonary injury, early stage, acute respiratory distress, Pneumocytes, Analysis, Deceased, deaths, followed by, respiratory distress, patient age, lung lesion, lung lesions, lung biopsy, lesion, Sample size, Clinical data, alteration, syndrome, hallmark, limited sample size, Spanish, males, English, Course, performed, carried, the disease, evaluated, form, median, characterized, pneumocyte, histopathological, histological, Limited, patients with COVID-19, prospectivo, Sin, 【제목키워드】 acute respiratory distress, syndrome, fatal COVID-19, feature,