Acute Respiratory Distress Syndrome (ARDS) is a well-recognized clinical problem first described in the late sixties. However, its relevance seems to have increased since the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) outbreak, as 14% (CI 95% 2% to 59%) of patients admitted to the hospital present with this syndrome. Conceptually, a syndrome is a group of symptoms and signs that correspond to several diseases. Although defining disease is much harder than may appear at first glance, we can view it as the association between a syndrome and a pathology pattern. Diffuse alveolar damage (DAD) is the morphological hallmark of ARDS, although studies performed in autopsies and patients have demonstrated that it is present in only half of ARDS patients. The SARS-CoV-2 outbreak and the high incidence of ARDS associated with this infection have triggered a natural question: is the lung pathology similar in patients with ARDS associated with traditional risk factors than to SARS-CoV-2 infection? This review aims to analyze the lung pathology results of patients infected with the novel SARS-Cov-2. As this article targets non-intensive care physicians, we will first describe the main characteristics of the novel SARS-Cov-2 and the ARDS definition, and then the lung pathology results from the UCI in this group of patients.
coronavirus, SARS-Cov-2 infection, lung pathology, acute respiratory distress syndrome
1. Ashbaugh D.G., Bigelow D.B., Petty T.L., Levine B.E. Acute respiratory distress in adults. Lancet. 1967; 2(7511): 319-323
2. Rubenfeld G.D., Caldwell E., Peabody E., Weaver J., Martin D.P., Neff M., et al. Incidence and outcomes of acute lung injury. The New England Journal of Medicine. 2005; 353(16): 1685-1693
3. Potere N., Valeriani E., Candeloro M., Tana M., Porreca E., Abbate A., et al. Acute complications and mortality in hospitalized patients with coronavirus disease 2019: a systematic review and meta-analysis. Critical Care. 2020; 24(1): 389 p.
4. Cardinal-Fernandez P., Correger E., Villanueva J., Rios F. Acute Respiratory Distress: from syndrome to disease. Medicina Intensiva. 2016; 40(3): 169-175
5. Katzenstein A.L., Bloor C.M., Leibow A.A. Diffuse alveolar damage--the role of oxygen, shock, and related factors. A review. The American Journal of Pathology. 1976; 85(1): 209-228
6. Force A.D.T., Ranieri V.M., Rubenfeld G.D., Thompson B.T., Ferguson N.D., Caldwell E., et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012; 307(23): 2526-2533
7. Cardinal-Fernandez P., Bajwa E.K., Dominguez-Calvo A., Menendez J.M., Papazian L., Thompson B.T. The Presence of Diffuse Alveolar Damage on Open Lung Biopsy Is Associated With Mortality in Patients With Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis. Chest. 2016; 149(5): 1155-1164
8. Cardinal-Fernandez P., Ortiz G., Chang C.H., Kao K.C., Bertreau E., Philipponnet C., et al. Predicting the Impact of Diffuse Alveolar Damage through Open Lung Biopsy in Acute Respiratory Distress Syndrome-The PREDATOR Study. Journal of Clinical Medicine. 2019; 8(6)
9. Zumla A., Chan J.F., Azhar E.I., Hui D.S., Yuen K.Y. Coronaviruses - drug discovery and therapeutic options. Nature Reviews Drug Discovery. 2016; 15(5): 327-347
10. Mohanty S.K., Satapathy A., Naidu M.M., Mukhopadhyay S., Sharma S., Barton L.M., et al. Severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2) and coronavirus disease 19 (COV-ID-19) - anatomic pathology perspective on current knowledge. Diagnostic Pathology. 2020; 15(1): 103 p.
11. Zhou P., Yang X.L., Wang X.G., Hu B., Zhang L., Zhang W., et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020; 579(7798): 270-273.
12. Wang D., Hu B., Hu C., Zhu F., Liu X., Zhang J., et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020.
13. Ferguson N.D., Fan E., Camporota L., Antonelli M., Anzueto A., Beale R., et al. The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Medicine. 2012; 38(10): 1573-1582
14. Forel J.M., Guervilly C., Hraiech S., Voillet F., Thomas G., Somma C., et al. Type III procollagen is a reliable marker of ARDS-associated lung fibroproliferation. Intensive Care Medicine. 2015; 41(1): 1-11
15. Lorente J.A., Cardinal-Fernandez P., Munoz D., Frutos-Vivar F., Thille A.W., Jaramillo C., et al. Acute respiratory distress syndrome in patients with and without diffuse alveolar damage: an autopsy study. Intensive Care Medicine. 2015; 41(11): 1921-1930
16. Rios F., Iscar T., Cardinal-Fernandez P. What every intensivist should know about acute respiratory distress syndrome and diffuse alveolar damage. The Revista Brasileira de Terapia Intensiva. 2017; 29(3):354-363
17. Cardinal-Fernandez P., Lorente J.A., Ballen-Barragan A., Matute-Bello G. Acute Respiratory Distress Syndrome and Diffuse Alveolar Damage. New Insights on a Complex Relationship. Annals of the American Thoracic Society. 2017; 14(6): 844-850
18. Cardinal-Fernandez P., Esteban A., Thompson B.T., Lorente J.A. ARDS: lessons learned from the heart. Chest. 2015; 147(1): 7-8
19. Magro C., Mulvey J.J., Berlin D., Nuovo G., Salvatore S., Harp J., et al. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COV-ID-19 infection: A report of five cases. Translational Research. 2020; (220): 1-13
20. Menter T., Haslbauer J.D., Nienhold R., Savic S., Hopfer H., Deigendesch N., et al. Postmortem examination of COV-ID-19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings in lungs and other organs suggesting vascular dysfunction. Histopathology. 2020.
21. Barnes B.J., Adrover J.M., Baxter-Stoltzfus A., Borczuk A., Cools-Lartigue J., Crawford J.M., et al. Targeting potential drivers of COV-ID-19: Neutrophil extracellular traps. Journal of Experimental Medicine. 2020; 217(6)
22. Rothberg M.B., Haessler S.D. Complications of seasonal and pandemic influenza. Critical Care Medicine. 2010; 38(S.4): e91-7
23. Liao S.C., Shao S.C., Chen Y.T., Chen Y.C., Hung M.J. Incidence and mortality of pulmonary embolism in COV-ID-19: a systematic review and meta-analysis. Critical Care. 2020; 24(1): 464 p.
24. Fogarty H., Townsend L., Ni Cheallaigh C., Bergin C., Martin-Loeches I., Browne P., et al. More on COV-ID-19 coagulopathy in Caucasian patients. British Journal of Haematology. 2020; 189(6): 1060-1061
25. Carsana L., Sonzogni A., Nasr A., Rossi R.S., Pellegrinelli A., Zerbi P., et al. Pulmonary post-mortem findings in a series of COV-ID-19 cases from northern Italy: a two-centre descriptive study. The Lancet Infectious Diseases. 2020.
26. Fox S.E., Akmatbekov A., Harbert J.L., Li G., Quincy Brown J., Vander Heide R.S. Pulmonary and cardiac pathology in African American patients with COV-ID-19: an autopsy series from New Orleans. The Lancet Respiratory Medicine. 2020; 8(7): 681-686