Time to consider histologic pattern of lung injury to treat critically ill patients with COVID-19 infection

Copin, Marie‐Christine; Parmentier, Erika; Duburcq, Thibault; Poissy, Julien; Mathieu, Daniel

doi:10.1007/s00134-020-06057-8

Cited by 259 publications

(286 citation statements)

References 6 publications

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“…17,16,15,23,14 Only Schaller et al reports a case with areas of brotic DAD in a patient with a 26-day disease-to-death course and mechanical ventilation for 21 days 14 . AFOP alone, with no DAD, was the only lesion described by one author 24 . In our study, AFOP was present in two of our cases, but always associated with DAD.…”

Section: Discussionmentioning

confidence: 88%

CT as a Tool to Depict Pulmonary Fibrosis in Patients With COVID-19: a Radiopathological Correlation

Alguersuari

Ortíz

Munné

et al. 2020

Preprint

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OBJECTIVESCT findings of COVID-19 infected patients has been well described, but it it’s roll in depicting signs of fibrosis in critically ill patients remains unclear. To our knowledge, there are no radiopathological correlations of the pulmonary pathology. Exudative and proliferative diffuse alveolar damage (DAD) are the most commonly reported injury. Few studies describe fibrosis, the last phase of DAD. Our study correlates post-mortem chest US and CT findings of COVID-19 infected patients with the histopathology from biopsies taken of the lung. It focuses on the role of CT to depict fibrosis. METHODSThis is a prospective observational study of six consecutive deceased patients infected with COVID-19. Post-mortem chest CTs and US were performed within 24 hours of death. CT and US were used to obtain biopsies of different radiological patterns. Pre-mortem CT examinations were also retrospectively evaluated. RESULTSOn CT, all patients presented with extensive areas of consolidation and ground-glass opacities affecting most segments of the lung. Pleural effusion was present in all cases. Four of the patients showed signs of fibrosis. On US, subpleural consolidation, pleural thickening, and B-pattern were present.All patients showed different stages of DAD, mostly proliferative DAD. Four patients presented with fibrotic DAD, all of which had been admitted for over three weeks and correlated with the CT findings of fibrosis. CONCLUSIONIn our study, signs of fibrosis on CT show a histopathological correlation. CT may be useful to identify the group of COVID-infected patients that develop fibrosis as a marker of poor prognosis, in the late stage of the disease.

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Section: Discussionmentioning

confidence: 88%

CT as a Tool to Depict Pulmonary Fibrosis in Patients With COVID-19: a Radiopathological Correlation

Alguersuari

Ortíz

Munné

et al. 2020

Preprint

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“…Therefore, increase in coagulation markers is foreseen. Interestingly acute brinous and organizing pneumonia (AFOP)-like pneumonia are described in SARS-Cov-2 infected patients [25]. Therefore it cannot be excluded that D-dimers increase could partly be related to the presence of brinogen in the lung compartment.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of routine biomarkers and blood leucocytes count to assist diagnosis of COVID-19-associated pneumonia in adult patients visiting the emergency department

Maincent¹,

Berthier²,

Farhad³

et al. 2020

Preprint

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Background To investigate whether routine biomarkers and blood leucocytes count could assist diagnosis of COVID-19-associated pneumonia in adult patients visiting the emergency department (ED). Methods This monocentre retrospective study enrolled 254 patients with nasopharyngeal RT-PCR for SARS-COV-2, routine biomarkers (D-dimers, fibrinogen, C-reactive protein, procalcitonin, NTpro-BNP, cTnT-hs) and blood cell counts. Sensitivity and specificity were evaluated. An adjudication committee classified diagnostic probability as certain, probable, unlikely, and excluded, based on all available data, then distributed in 2 categories: high (certain and probable) and low probability (unlikely and excluded). Results Between 25 th of February and 15 th of April, 2020, 254 of 388 patients could be analyzed. The adjudication committee classified 46 patients as definite, 18 as probable, 64 as unlikely, and 126 as excluded, corresponding to 64 high and 190 low probability. High and low probability patients differed for fibrinogen (P<0.0005) and white blood cell counts, notably leucocytes (P=0.0015), neutrophilic (P=0.0036), lymphocytes (P=0.0057), eosinophilic (P=0.027), and basophilic (P<0.001) counts. In a multivariate analysis, basophilic count < 25/µL (OR 3.048 [95%CI; 1.34-6.919]), neutrophilic count < 4000 /µL (OR 5.525 [95%CI; 2.20-13.855], and fibrinogen > 3g/L (OR 6355 [95%CI; 2.01-20.079] were independently associated with the diagnosis. Negative predictive values were 0.98 and 0.93 combining fibrinogen ( < 3g/L) and eosinophilic count ( < 80/µL), and fibrinogen and basophilic count ( < 25/µL), respectively. Conclusion Changes in fibrinogen and white blood cells, notably basophilic count, showed interesting performance for the diagnosis COVID-19 associated pneumonia. Combining fibrinogen with either eosinophilic or basophilic count was helpful to exclude the diagnosis.

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“…[9][10][11][12][13] Recent clinical and anatomopathological reports have described the endothelial damage as one of the most prominent causes of the systemic vascular thromboembolic and/or in ammatory manifestations of COVID-19. [32][33][34] In this setting, the retina as a privileged district for non-invasive and in vivo evaluation of systemic diseases, may reveal alterations such as vascular occlusion related to the thrombotic susceptibility and chorioretinitis or vasculitis directly mediated by the virus. Hence, as reported in the brain, we considered the possibility of a direct ocular spread of SARS-CoV-2 through the two blood-retinal barriers (BRBs).…”

Section: Discussionmentioning

confidence: 99%

Ocular findings and retinal involvement in COVID-19 pneumonia patients: A cross-sectional study in an Italian referral centre

Pirraglia¹,

Ceccarelli²,

Cerini³

et al. 2020

Preprint

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Background: changes in immune and coagulation systems and possible viral spread through blood-brain barrier have been described in SARS-CoV-2 infection. In this study, we evaluate the possible retinal involvement and ocular findings in severe COVID-19 pneumonia patients. Methods: a cross sectional study was conducted on 46 patients affected by severe COVID-19 who were hospitalized in one Intensive Care Unit (ICU) and in two Infectious Diseases wards, including a bedside eye screening, corneal sensitivity assessment and retinography. Results: a total of 43 SARS-CoV-2 positive pneumonia patients affected with COVID-19 pneumonia were included, 25 males and 18 females, with a median age of 70 [IQR 59-78]. Except for one patient with unilateral posterior chorioretinitis of opportunistic origin, of whom aqueous tap was negative for SARS-CoV-2, no further retinal manifestation related to COVID-19 infection was found in our cohort. We found 3 patients (7%) with bilateral conjunctivitis in whom PCR analysis on conjunctival swab provided negative results for SARS-CoV-2. No alterations of corneal sensitivity were found.Conclusion: we demonstrated the absence of retinal involvement in SARS-CoV-2 pneumonia patients. Ophthalmologic evaluation in COVID-19, particularly in patients hospitalized in an ICU setting, may be useful to reveal systemic co-infections by opportunistic pathogens.

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Time to consider histologic pattern of lung injury to treat critically ill patients with COVID-19 infection

Cited by 259 publications

References 6 publications

CT as a Tool to Depict Pulmonary Fibrosis in Patients With COVID-19: a Radiopathological Correlation

CT as a Tool to Depict Pulmonary Fibrosis in Patients With COVID-19: a Radiopathological Correlation

Accuracy of routine biomarkers and blood leucocytes count to assist diagnosis of COVID-19-associated pneumonia in adult patients visiting the emergency department

Ocular findings and retinal involvement in COVID-19 pneumonia patients: A cross-sectional study in an Italian referral centre

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