Selected article for: "acute respiratory distress syndrome and low compliance"
Author: Batah, S.; Benatti, M.; Siyuan, L.; Telini, W.; Barbosa, J.; Menezes, M.; Nadai, T.; S, K.; Vaswani, C.; Gupta, S.; Zamboni, D.; Wada, D.; Calado, R.; Oliveira, R.; Louzada-Junior, P.; Auxiliadora-Martins, M.; Veras, F.; Cunha, L.; Cunha, T.; Luppino-Assad, R.; Balancin, M.; Morais, S.; Martins, R.; Arruda, E.; Chahud, F.; Koenigkam-Santos, M.; Cetlin, A.; Cunha, F.; Santos, C.; Capelozzi, V.; Fukuoka, J.; Duarte-Achcar, R.; Fabro, A.
Title: COVID-19 Bimodal Clinical and Pathological Phenotypes
  • Cord-id: x529fnie
  • Document date: 2021_9_14
    • ID: x529fnie
    Snippet: Background Patients with coronavirus disease-2019 (COVID-19) present varying clinical complications. Different viral load and host response related to genetic and immune background are probably the reasons for these differences. We aimed to sought clinical and pathological correlation that justifies the different clinical outcomes among COVID-19 autopsies cases. Methods Minimally invasive autopsy was performed on forty-seven confirmed COVID-19 patients from May-July, 2020. Electronic medical rec
    Document: Background Patients with coronavirus disease-2019 (COVID-19) present varying clinical complications. Different viral load and host response related to genetic and immune background are probably the reasons for these differences. We aimed to sought clinical and pathological correlation that justifies the different clinical outcomes among COVID-19 autopsies cases. Methods Minimally invasive autopsy was performed on forty-seven confirmed COVID-19 patients from May-July, 2020. Electronic medical record of all patients was collected and a comprehensive histopathological evaluation was performed. Immunohistochemistry, immunofluorescence, special stain, western blotting and post-mortem real-time reverse transcriptase polymerase chain reaction on fresh lung tissue were performed. Resultss We show that 5/47 (10,6%) patients present a progressive decline in oxygenation index for acute respiratory distress syndrome (PaO2/FiO2 ratio), low compliance levels, interstitial fibrosis, high -SMA+ cells/protein expression, high collagens I/III deposition and NETs(P<0.05), named as fibrotic phenotype (N=5). Conversely, 10/47 (21,2%) patients demonstrated progressive increase in PaO2/FiO2 ratio, high pulmonary compliance levels, preserved elastic framework, increase thrombus formation and high platelets and D-dimer levels at admission (P<0.05), named as thrombotic phenotype. While 32/47 (68,1%) had a mixed phenotypes between both ones. Conclusions We believe that categorization of patients based on these two phenotypes can be used to develop prognostic tools and potential therapies since the PaO2/FiO2 ratio variation and D-dimer levels correlate with the underlying fibrotic or thrombotic pathologic process, respectively; which may indicate possible clinical outcome of the patient.

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