Diffuse alveolar damage (DAD) resulting from coronavirus disease 2019 Infection is Morphologically Indistinguishable from Other Causes of DAD
Diffuse alveolar damage (DAD) resulting from coronavirus disease 2019 Infection is Morphologically Indistinguishable from Other Causes of DAD
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DOI：
10.1111/his.14180
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发表时间：
2020-09-12
期刊：
影响因子：
6.4
通讯作者：
Myers, Jeffrey L.
中科院分区：
文献类型：
--
作者：
Konopka, Kristine E.;Nguyen, Teresa;Myers, Jeffrey L.
AIMS弥漫性肺泡损伤(DAD)是2019年住院冠状病毒病(新冠肺炎)相关死亡中普遍存在的发现，但最近的报告也描述了其他非典型发现，包括血管变化。这项研究的目的是评估新冠肺炎住院患者和社区死亡的严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)阳性患者的肺尸检结果，以了解医疗干预对肺组织学的相对影响。此外，我们的目的是通过将病理结果与未感染的对照组患者的病理结果进行比较，来调查新冠肺炎是否代表了DAD的一种独特的组织学变体。方法和结果3名肺部病理学家对尸检病例的肺切片进行复查，其中2名对患者队列进行盲法检查。队列包括4例新冠肺炎住院患者，4例死于社区的SARS-CoV-2尸检病例和8例SARS-CoV-2阴性对照病例。除了一名SARS-CoV-2阳性患者外，所有患者都有父亲在场，该患者没有症状，在社区死亡。尽管SARS-CoV-2阳性患者比对照组患者有更多的局灶性血管周围炎症/内皮炎，但两组患者在透明膜、纤维蛋白血栓、空隙组织以及类似急性纤维蛋白和器质性肺炎的肺泡内纤维蛋白沉积方面没有显著差异。纤维素样血管壁坏死、出血和毛细血管炎症不是新冠肺炎相关性DAD的特征。结论DAD是新冠肺炎院内和社区死亡的重症肺部疾病患者的主要组织学表现，提示高氧机械通气对其组织学改变无贡献。没有明显的形态学特征来区分新冠肺炎相关的父亲和其他原因的父亲。
Aims Diffuse alveolar damage (DAD) is a ubiquitous finding in inpatient coronavirus disease 2019 (COVID-19)-related deaths, but recent reports have also described additional atypical findings, including vascular changes. An aim of this study was to assess lung autopsy findings in COVID-19 inpatients, and in untreated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive individuals who died in the community, in order to understand the relative impact of medical intervention on lung histology. Additionally, we aimed to investigate whether COVID-19 represents a unique histological variant of DAD by comparing the pathological findings with those of uninfected control patients. Methods and results Lung sections from autopsy cases were reviewed by three pulmonary pathologists, including two who were blinded to patient cohort. The cohorts included four COVID-19 inpatients, four cases with postmortem SARS-CoV-2 diagnoses who died in the community, and eight SARS-CoV-2-negative control cases. DAD was present in all but one SARS-CoV-2-positive patient, who was asymptomatic and died in the community. Although SARS-CoV-2-positive patients were noted to have more focal perivascular inflammation/endothelialitis than control patients, there were no significant differences in the presence of hyaline membranes, fibrin thrombi, airspace organisation, and 'acute fibrinous and organising pneumonia'-like intra-alveolar fibrin deposition between the cohorts. Fibrinoid vessel wall necrosis, haemorrhage and capillaritis were not features of COVID-19-related DAD. Conclusions DAD is the primary histological manifestation of severe lung disease in COVID-19 patients who die both in hospital and in the community, suggesting no contribution of hyperoxaemic mechanical ventilation to the histological changes. There are no distinctive morphological features with which to confidently differentiate COVID-19-related DAD from DAD due to other causes.