Ultrasound assessment of pulmonary fibroproliferative changes in severe COVID-19: a quantitative correlation study with histopathological findings.

Autor: de Almeida Monteiro RA; Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Sao Paulo, SP, 01246-903, Brazil., Duarte-Neto AN; Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Sao Paulo, SP, 01246-903, Brazil., Ferraz da Silva LF; Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Sao Paulo, SP, 01246-903, Brazil.; Serviço de Verificação de Óbitos da Capital, Universidade de São Paulo, Sao Paulo, Brazil., de Oliveira EP; Departamento de Cardiopneumologia, Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil., do Nascimento ECT; Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Sao Paulo, SP, 01246-903, Brazil., Mauad T; Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Sao Paulo, SP, 01246-903, Brazil., Saldiva PHDN; Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Sao Paulo, SP, 01246-903, Brazil., Dolhnikoff M; Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Sao Paulo, SP, 01246-903, Brazil. maridol@usp.br.
Jazyk: angličtina
Zdroj: Intensive care medicine [Intensive Care Med] 2021 Feb; Vol. 47 (2), pp. 199-207. Date of Electronic Publication: 2021 Jan 03.
DOI: 10.1007/s00134-020-06328-4
Abstrakt: Purpose: This study was designed to evaluate the usefulness of lung ultrasound (LUS) imaging to characterize the progression and severity of lung damage in cases of COVID-19.
Methods: We employed a set of combined ultrasound parameters and histopathological images obtained simultaneously in 28 patients (15 women, 0.6-83 years) with fatal COVID-19 submitted to minimally invasive autopsies, with different times of disease evolution from initial symptoms to death (3-37 days, median 18 days). For each patient, we analysed eight post-mortem LUS parameters and the proportion of three histological patterns (normal lung, exudative diffuse alveolar damage [DAD] and fibroproliferative DAD) in eight different lung regions. The relationship between histopathological and post-mortem ultrasonographic findings was assessed using various statistical approaches.
Results: Statistically significant positive correlations were observed between fibroproliferative DAD and peripheral consolidation (coefficient 0.43, p = 0.02) and pulmonary consolidation (coefficient 0.51, p = 0.005). A model combining age, time of evolution, sex and ultrasound score predicted reasonably well (r = 0.66) the proportion of pulmonary parenchyma with fibroproliferative DAD.
Conclusion: The present study adds information to previous studies related to the use of LUS as a tool to assess the severity of acute pulmonary damage. We provide a histological background that supports the concept that LUS can be used to characterize the progression and severity of lung damage in severe COVID-19.
Databáze: MEDLINE
Externí odkaz: