The Pathology of Severe COVID-19-Related Lung Damage.
Identifieur interne : 000168 ( Main/Exploration ); précédent : 000167; suivant : 000169The Pathology of Severe COVID-19-Related Lung Damage.
Auteurs : Felix K F. Kommoss ; Constantin Schwab ; Luca Tavernar ; Johannes Schreck ; Willi L. Wagner ; Uta Merle ; Danny Jonigk ; Peter Schirmacher ; Thomas LongerichSource :
- Deutsches Arzteblatt international [ 1866-0452 ] ; 2020.
Descripteurs français
- KwdFr :
- Adulte (MeSH), Adulte d'âge moyen (MeSH), Femelle (MeSH), Humains (MeSH), Indice de gravité de la maladie (MeSH), Infections à coronavirus (complications), Lésion pulmonaire (anatomopathologie), Lésion pulmonaire (virologie), Mâle (MeSH), Pandémies (MeSH), Pneumopathie virale (complications), Sujet âgé (MeSH), Sujet âgé de 80 ans ou plus (MeSH).
- MESH :
- anatomopathologie : Lésion pulmonaire.
- virologie : Lésion pulmonaire.
- complications : Adulte, Adulte d'âge moyen, Femelle, Humains, Indice de gravité de la maladie, Infections à coronavirus, Mâle, Pandémies, Pneumopathie virale, Sujet âgé, Sujet âgé de 80 ans ou plus.
English descriptors
- KwdEn :
- MESH :
- complications : Coronavirus Infections, Pneumonia, Viral.
- pathology : Lung Injury.
- virology : Lung Injury.
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Pandemics, Severity of Illness Index.
Abstract
BACKGROUND
The histomorphological changes of lung damage in severe coronavirus disease 2019 (COVID-19) have not yet been adequately characterized. In this article, we describe the sequence of pathological changes in COVID-19 and discuss the implications for approaches to treatment.
METHODS
Standardized autopsies were performed on thirteen patients who had died of COVID-19. The findings were analyzed together with clinical data from the patients' medical records.
RESULTS
Most (77%) of the deceased patients were men. Their median age at death was 78 years (range, 41-90). Most of them had major pre-existing chronic diseases, most commonly arterial hypertension. The autopsies revealed characteristic COVID-19-induced pathological changes in the lungs, which were regarded as the cause of death in most patients. The main histological finding was sequential alveolar damage, apparently due in large measure to focal capillary microthrombus formation. Alveolar damage leads to the death of the patient either directly or by the induction of pulmonary parenchymal fibrosis. Diffuse lung damage was seen exclusively in invasively ventilated patients.
CONCLUSION
Autopsies are crucial for the systematic assessment of new diseases such as COVID-19: they provide a basis for further investigations of disease mechanisms and for the devising of potentially effective modes of treatment. The autopsy findings suggest that focal damage of the microvascular pulmonary circulation is a main mechanism of lethal lung disease due to the SARS-CoV-2 virus. It may also be a cause of persistent lung damage in patients who recover from severe COVID-19.
DOI: 10.3238/arztebl.2020.0500
PubMed: 32865490
Affiliations:
Links toward previous steps (curation, corpus...)
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Kommoss</name><affiliation><nlm:affiliation>Institute of Pathology, University Hospital Heidelberg; Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), University Hospital Heidelberg; Department of Gastroenterology and Hepatology, University Hospital Heidelberg; Institute of Pathology, Hannover Medical School; Biomedical Research in Endstage and Obstructive Lung Dis ease Hannover (BREATH), Center for Lung Research (DZL), Hannover Medical School; TI Biobank; German Center for Infection Research (DZIF), - University Hospital Heidelberg.</nlm:affiliation><wicri:noCountry code="subField">- University Hospital Heidelberg</wicri:noCountry></affiliation></author><author><name sortKey="Schwab, Constantin" sort="Schwab, Constantin" uniqKey="Schwab C" first="Constantin" last="Schwab">Constantin Schwab</name></author><author><name sortKey="Tavernar, Luca" sort="Tavernar, Luca" uniqKey="Tavernar L" first="Luca" last="Tavernar">Luca Tavernar</name></author><author><name sortKey="Schreck, Johannes" sort="Schreck, Johannes" uniqKey="Schreck J" first="Johannes" last="Schreck">Johannes Schreck</name></author><author><name sortKey="Wagner, Willi L" sort="Wagner, Willi L" uniqKey="Wagner W" first="Willi L" last="Wagner">Willi L. Wagner</name></author><author><name sortKey="Merle, Uta" sort="Merle, Uta" uniqKey="Merle U" first="Uta" last="Merle">Uta Merle</name></author><author><name sortKey="Jonigk, Danny" sort="Jonigk, Danny" uniqKey="Jonigk D" first="Danny" last="Jonigk">Danny Jonigk</name></author><author><name sortKey="Schirmacher, Peter" sort="Schirmacher, Peter" uniqKey="Schirmacher P" first="Peter" last="Schirmacher">Peter Schirmacher</name></author><author><name sortKey="Longerich, Thomas" sort="Longerich, Thomas" uniqKey="Longerich T" first="Thomas" last="Longerich">Thomas Longerich</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:32865490</idno><idno type="pmid">32865490</idno><idno type="doi">10.3238/arztebl.2020.0500</idno><idno type="wicri:Area/Main/Corpus">000421</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000421</idno><idno type="wicri:Area/Main/Curation">000421</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Curation">000421</idno><idno type="wicri:Area/Main/Exploration">000421</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">The Pathology of Severe COVID-19-Related Lung Damage.</title><author><name sortKey="Kommoss, Felix K F" sort="Kommoss, Felix K F" uniqKey="Kommoss F" first="Felix K F" last="Kommoss">Felix K F. Kommoss</name><affiliation><nlm:affiliation>Institute of Pathology, University Hospital Heidelberg; Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), University Hospital Heidelberg; Department of Gastroenterology and Hepatology, University Hospital Heidelberg; Institute of Pathology, Hannover Medical School; Biomedical Research in Endstage and Obstructive Lung Dis ease Hannover (BREATH), Center for Lung Research (DZL), Hannover Medical School; TI Biobank; German Center for Infection Research (DZIF), - University Hospital Heidelberg.</nlm:affiliation><wicri:noCountry code="subField">- University Hospital Heidelberg</wicri:noCountry></affiliation></author><author><name sortKey="Schwab, Constantin" sort="Schwab, Constantin" uniqKey="Schwab C" first="Constantin" last="Schwab">Constantin Schwab</name></author><author><name sortKey="Tavernar, Luca" sort="Tavernar, Luca" uniqKey="Tavernar L" first="Luca" last="Tavernar">Luca Tavernar</name></author><author><name sortKey="Schreck, Johannes" sort="Schreck, Johannes" uniqKey="Schreck J" first="Johannes" last="Schreck">Johannes Schreck</name></author><author><name sortKey="Wagner, Willi L" sort="Wagner, Willi L" uniqKey="Wagner W" first="Willi L" last="Wagner">Willi L. Wagner</name></author><author><name sortKey="Merle, Uta" sort="Merle, Uta" uniqKey="Merle U" first="Uta" last="Merle">Uta Merle</name></author><author><name sortKey="Jonigk, Danny" sort="Jonigk, Danny" uniqKey="Jonigk D" first="Danny" last="Jonigk">Danny Jonigk</name></author><author><name sortKey="Schirmacher, Peter" sort="Schirmacher, Peter" uniqKey="Schirmacher P" first="Peter" last="Schirmacher">Peter Schirmacher</name></author><author><name sortKey="Longerich, Thomas" sort="Longerich, Thomas" uniqKey="Longerich T" first="Thomas" last="Longerich">Thomas Longerich</name></author></analytic><series><title level="j">Deutsches Arzteblatt international</title><idno type="eISSN">1866-0452</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>Aged (MeSH)</term><term>Aged, 80 and over (MeSH)</term><term>Coronavirus Infections (complications)</term><term>Female (MeSH)</term><term>Humans (MeSH)</term><term>Lung Injury (pathology)</term><term>Lung Injury (virology)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>Pandemics (MeSH)</term><term>Pneumonia, Viral (complications)</term><term>Severity of Illness Index (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte (MeSH)</term><term>Adulte d'âge moyen (MeSH)</term><term>Femelle (MeSH)</term><term>Humains (MeSH)</term><term>Indice de gravité de la maladie (MeSH)</term><term>Infections à coronavirus (complications)</term><term>Lésion pulmonaire (anatomopathologie)</term><term>Lésion pulmonaire (virologie)</term><term>Mâle (MeSH)</term><term>Pandémies (MeSH)</term><term>Pneumopathie virale (complications)</term><term>Sujet âgé (MeSH)</term><term>Sujet âgé de 80 ans ou plus (MeSH)</term></keywords><keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Lésion pulmonaire</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Coronavirus Infections</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Lung Injury</term></keywords><keywords scheme="MESH" qualifier="virologie" xml:lang="fr"><term>Lésion pulmonaire</term></keywords><keywords scheme="MESH" qualifier="virology" xml:lang="en"><term>Lung Injury</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Pandemics</term><term>Severity of Illness Index</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Femelle</term><term>Humains</term><term>Indice de gravité de la maladie</term><term>Infections à coronavirus</term><term>Mâle</term><term>Pandémies</term><term>Pneumopathie virale</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>The histomorphological changes of lung damage in severe coronavirus disease 2019 (COVID-19) have not yet been adequately characterized. In this article, we describe the sequence of pathological changes in COVID-19 and discuss the implications for approaches to treatment.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>Standardized autopsies were performed on thirteen patients who had died of COVID-19. The findings were analyzed together with clinical data from the patients' medical records.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>Most (77%) of the deceased patients were men. Their median age at death was 78 years (range, 41-90). Most of them had major pre-existing chronic diseases, most commonly arterial hypertension. The autopsies revealed characteristic COVID-19-induced pathological changes in the lungs, which were regarded as the cause of death in most patients. The main histological finding was sequential alveolar damage, apparently due in large measure to focal capillary microthrombus formation. Alveolar damage leads to the death of the patient either directly or by the induction of pulmonary parenchymal fibrosis. Diffuse lung damage was seen exclusively in invasively ventilated patients.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSION</b></p><p>Autopsies are crucial for the systematic assessment of new diseases such as COVID-19: they provide a basis for further investigations of disease mechanisms and for the devising of potentially effective modes of treatment. The autopsy findings suggest that focal damage of the microvascular pulmonary circulation is a main mechanism of lethal lung disease due to the SARS-CoV-2 virus. It may also be a cause of persistent lung damage in patients who recover from severe COVID-19.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" IndexingMethod="Curated" Owner="NLM"><PMID Version="1">32865490</PMID><DateCompleted><Year>2020</Year><Month>09</Month><Day>04</Day></DateCompleted><DateRevised><Year>2020</Year><Month>09</Month><Day>04</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">1866-0452</ISSN><JournalIssue CitedMedium="Internet"><Volume>117</Volume><Issue>29-30</Issue><PubDate><Year>2020</Year><Month>07</Month><Day>20</Day></PubDate></JournalIssue><Title>Deutsches Arzteblatt international</Title><ISOAbbreviation>Dtsch Arztebl Int</ISOAbbreviation></Journal><ArticleTitle>The Pathology of Severe COVID-19-Related Lung Damage.</ArticleTitle><Pagination><MedlinePgn>500-506</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.3238/arztebl.2020.0500</ELocationID><ELocationID EIdType="pii" ValidYN="Y">arztebl.2020.0500</ELocationID><Abstract><AbstractText Label="BACKGROUND">The histomorphological changes of lung damage in severe coronavirus disease 2019 (COVID-19) have not yet been adequately characterized. In this article, we describe the sequence of pathological changes in COVID-19 and discuss the implications for approaches to treatment.</AbstractText><AbstractText Label="METHODS">Standardized autopsies were performed on thirteen patients who had died of COVID-19. The findings were analyzed together with clinical data from the patients' medical records.</AbstractText><AbstractText Label="RESULTS">Most (77%) of the deceased patients were men. Their median age at death was 78 years (range, 41-90). Most of them had major pre-existing chronic diseases, most commonly arterial hypertension. The autopsies revealed characteristic COVID-19-induced pathological changes in the lungs, which were regarded as the cause of death in most patients. The main histological finding was sequential alveolar damage, apparently due in large measure to focal capillary microthrombus formation. Alveolar damage leads to the death of the patient either directly or by the induction of pulmonary parenchymal fibrosis. Diffuse lung damage was seen exclusively in invasively ventilated patients.</AbstractText><AbstractText Label="CONCLUSION">Autopsies are crucial for the systematic assessment of new diseases such as COVID-19: they provide a basis for further investigations of disease mechanisms and for the devising of potentially effective modes of treatment. The autopsy findings suggest that focal damage of the microvascular pulmonary circulation is a main mechanism of lethal lung disease due to the SARS-CoV-2 virus. It may also be a cause of persistent lung damage in patients who recover from severe COVID-19.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Kommoss</LastName><ForeName>Felix K F</ForeName><Initials>FKF</Initials><AffiliationInfo><Affiliation>Institute of Pathology, University Hospital Heidelberg; Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), University Hospital Heidelberg; Department of Gastroenterology and Hepatology, University Hospital Heidelberg; Institute of Pathology, Hannover Medical School; Biomedical Research in Endstage and Obstructive Lung Dis ease Hannover (BREATH), Center for Lung Research (DZL), Hannover Medical School; TI Biobank; German Center for Infection Research (DZIF), - University Hospital Heidelberg.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Schwab</LastName><ForeName>Constantin</ForeName><Initials>C</Initials></Author><Author ValidYN="Y"><LastName>Tavernar</LastName><ForeName>Luca</ForeName><Initials>L</Initials></Author><Author ValidYN="Y"><LastName>Schreck</LastName><ForeName>Johannes</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>Wagner</LastName><ForeName>Willi L</ForeName><Initials>WL</Initials></Author><Author ValidYN="Y"><LastName>Merle</LastName><ForeName>Uta</ForeName><Initials>U</Initials></Author><Author ValidYN="Y"><LastName>Jonigk</LastName><ForeName>Danny</ForeName><Initials>D</Initials></Author><Author ValidYN="Y"><LastName>Schirmacher</LastName><ForeName>Peter</ForeName><Initials>P</Initials></Author><Author ValidYN="Y"><LastName>Longerich</LastName><ForeName>Thomas</ForeName><Initials>T</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal 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PubStatus="received"><Year>2020</Year><Month>05</Month><Day>28</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2020</Year><Month>05</Month><Day>28</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2020</Year><Month>06</Month><Day>22</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>9</Month><Day>1</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>9</Month><Day>1</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>9</Month><Day>5</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">32865490</ArticleId><ArticleId IdType="pii">arztebl.2020.0500</ArticleId><ArticleId IdType="doi">10.3238/arztebl.2020.0500</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list></list><tree><noCountry><name sortKey="Jonigk, Danny" sort="Jonigk, Danny" uniqKey="Jonigk D" first="Danny" last="Jonigk">Danny Jonigk</name><name sortKey="Kommoss, Felix K F" sort="Kommoss, Felix K F" uniqKey="Kommoss F" first="Felix K F" last="Kommoss">Felix K F. Kommoss</name><name sortKey="Longerich, Thomas" sort="Longerich, Thomas" uniqKey="Longerich T" first="Thomas" last="Longerich">Thomas Longerich</name><name sortKey="Merle, Uta" sort="Merle, Uta" uniqKey="Merle U" first="Uta" last="Merle">Uta Merle</name><name sortKey="Schirmacher, Peter" sort="Schirmacher, Peter" uniqKey="Schirmacher P" first="Peter" last="Schirmacher">Peter Schirmacher</name><name sortKey="Schreck, Johannes" sort="Schreck, Johannes" uniqKey="Schreck J" first="Johannes" last="Schreck">Johannes Schreck</name><name sortKey="Schwab, Constantin" sort="Schwab, Constantin" uniqKey="Schwab C" first="Constantin" last="Schwab">Constantin Schwab</name><name sortKey="Tavernar, Luca" sort="Tavernar, Luca" uniqKey="Tavernar L" first="Luca" last="Tavernar">Luca Tavernar</name><name sortKey="Wagner, Willi L" sort="Wagner, Willi L" uniqKey="Wagner W" first="Willi L" last="Wagner">Willi L. 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