Vasculopathy and Increased Vascular Congestion in Fatal COVID-19 and Acute Respiratory Distress Syndrome.

Autor: Villalba JA; James Homer Wright Pathology Laboratories.; Department of Pathology, Harvard Medical School, Boston, Massachusetts., Hilburn CF; James Homer Wright Pathology Laboratories.; Department of Pathology, Harvard Medical School, Boston, Massachusetts., Garlin MA; Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts.; Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York., Elliott GA; Unboxed Systems LLC, West Palm Beach, Florida., Li Y; Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts., Kunitoki K; Harvard T. H. Chan School of Public Health, Boston, Massachusetts.; Department of Psychiatry., Poli S; Department of Medicine, Mount Sinai Medical Center, Miami Beach, Florida., Alba GA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Department of Medicine., Madrigal E; James Homer Wright Pathology Laboratories.; Department of Pathology, Harvard Medical School, Boston, Massachusetts., Taso M; Division of MRI Research, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts., Price MC; Division of Thoracic Imaging and Intervention, Department of Radiology., Aviles AJ; James Homer Wright Pathology Laboratories., Araujo-Medina M; James Homer Wright Pathology Laboratories.; Immunopathology Research Laboratory, and., Bonanno L; James Homer Wright Pathology Laboratories.; Department of Pathology, Harvard Medical School, Boston, Massachusetts., Boyraz B; James Homer Wright Pathology Laboratories.; Department of Pathology, Harvard Medical School, Boston, Massachusetts., Champion SN; James Homer Wright Pathology Laboratories.; Department of Pathology, Harvard Medical School, Boston, Massachusetts.; C. S. Kubik Laboratory for Neuropathology, Department of Pathology, Massachusetts General Hospital Charlestown HealthCare Center, Charlestown, Massachusetts.; Miami-Dade County Medical Examiner Department, Miami, Florida., Harris CK; James Homer Wright Pathology Laboratories.; Department of Pathology, Harvard Medical School, Boston, Massachusetts., Helland TL; James Homer Wright Pathology Laboratories.; Department of Pathology, Harvard Medical School, Boston, Massachusetts., Hutchison B; James Homer Wright Pathology Laboratories.; Department of Pathology, Harvard Medical School, Boston, Massachusetts., Jobbagy S; James Homer Wright Pathology Laboratories.; Department of Pathology, Harvard Medical School, Boston, Massachusetts., Marshall MS; James Homer Wright Pathology Laboratories.; Department of Pathology, Harvard Medical School, Boston, Massachusetts., Shepherd DJ; James Homer Wright Pathology Laboratories.; Department of Pathology, Harvard Medical School, Boston, Massachusetts., Barth JL; James Homer Wright Pathology Laboratories., Hung YP; James Homer Wright Pathology Laboratories.; Department of Pathology, Harvard Medical School, Boston, Massachusetts., Ly A; James Homer Wright Pathology Laboratories.; Department of Pathology, Harvard Medical School, Boston, Massachusetts., Hariri LP; James Homer Wright Pathology Laboratories.; Department of Pathology, Harvard Medical School, Boston, Massachusetts.; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Department of Medicine., Turbett SE; James Homer Wright Pathology Laboratories.; Department of Pathology, Harvard Medical School, Boston, Massachusetts.; Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts., Pierce VM; James Homer Wright Pathology Laboratories.; Department of Pathology, Harvard Medical School, Boston, Massachusetts.; Pediatric Infectious Disease Unit, MassGeneral Hospital for Children, Boston, Massachusetts., Branda JA; James Homer Wright Pathology Laboratories.; Department of Pathology, Harvard Medical School, Boston, Massachusetts., Rosenberg ES; James Homer Wright Pathology Laboratories.; Department of Pathology, Harvard Medical School, Boston, Massachusetts.; Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts., Mendez-Pena J; James Homer Wright Pathology Laboratories., Chebib I; James Homer Wright Pathology Laboratories.; Department of Pathology, Harvard Medical School, Boston, Massachusetts., Rosales IA; James Homer Wright Pathology Laboratories.; Department of Pathology, Harvard Medical School, Boston, Massachusetts.; Immunopathology Research Laboratory, and., Smith RN; James Homer Wright Pathology Laboratories.; Department of Pathology, Harvard Medical School, Boston, Massachusetts.; Immunopathology Research Laboratory, and., Miller MA; Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts., Rosas IO; Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas., Hardin CC; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Department of Medicine., Baden LR; Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts., Medoff BD; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Department of Medicine., Colvin RB; James Homer Wright Pathology Laboratories.; Department of Pathology, Harvard Medical School, Boston, Massachusetts.; Immunopathology Research Laboratory, and., Little BP; Division of Thoracic Imaging and Intervention, Department of Radiology.; Division of Cardiothoracic Imaging, Department of Radiology, Mayo Clinic Florida, Jacksonville, Florida., Stone JR; James Homer Wright Pathology Laboratories.; Department of Pathology, Harvard Medical School, Boston, Massachusetts., Mino-Kenudson M; James Homer Wright Pathology Laboratories.; Department of Pathology, Harvard Medical School, Boston, Massachusetts., Shih AR; James Homer Wright Pathology Laboratories.; Department of Pathology, Harvard Medical School, Boston, Massachusetts.
Jazyk: angličtina
Zdroj: American journal of respiratory and critical care medicine [Am J Respir Crit Care Med] 2022 Oct 01; Vol. 206 (7), pp. 857-873.
DOI: 10.1164/rccm.202109-2150OC
Abstrakt: Rationale: The leading cause of death in coronavirus disease 2019 (COVID-19) is severe pneumonia, with many patients developing acute respiratory distress syndrome (ARDS) and diffuse alveolar damage (DAD). Whether DAD in fatal COVID-19 is distinct from other causes of DAD remains unknown. Objective: To compare lung parenchymal and vascular alterations between patients with fatal COVID-19 pneumonia and other DAD-causing etiologies using a multidimensional approach. Methods: This autopsy cohort consisted of consecutive patients with COVID-19 pneumonia ( n  = 20) and with respiratory failure and histologic DAD ( n  = 21; non-COVID-19 viral and nonviral etiologies). Premortem chest computed tomography (CT) scans were evaluated for vascular changes. Postmortem lung tissues were compared using histopathological and computational analyses. Machine-learning-derived morphometric analysis of the microvasculature was performed, with a random forest classifier quantifying vascular congestion (C Vasc ) in different microscopic compartments. Respiratory mechanics and gas-exchange parameters were evaluated longitudinally in patients with ARDS. Measurements and Main Results: In premortem CT, patients with COVID-19 showed more dilated vasculature when all lung segments were evaluated ( P  = 0.001) compared with controls with DAD. Histopathology revealed vasculopathic changes, including hemangiomatosis-like changes ( P  = 0.043), thromboemboli ( P  = 0.0038), pulmonary infarcts ( P  = 0.047), and perivascular inflammation ( P  < 0.001). Generalized estimating equations revealed significant regional differences in the lung microarchitecture among all DAD-causing entities. COVID-19 showed a larger overall C Vasc range ( P  = 0.002). Alveolar-septal congestion was associated with a significantly shorter time to death from symptom onset ( P  = 0.03), length of hospital stay ( P  = 0.02), and increased ventilatory ratio [an estimate for pulmonary dead space fraction ( V d ); p  = 0.043] in all cases of ARDS. Conclusions: Severe COVID-19 pneumonia is characterized by significant vasculopathy and aberrant alveolar-septal congestion. Our findings also highlight the role that vascular alterations may play in V d and clinical outcomes in ARDS in general.
Databáze: MEDLINE
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