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10.1164/rccm.202109-2150OC

http://scihub22266oqcxt.onion/10.1164/rccm.202109-2150OC
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35671465!9799276!35671465
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suck abstract from ncbi


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pmid35671465      Am+J+Respir+Crit+Care+Med 2022 ; 206 (7): 857-873
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  • Vasculopathy and Increased Vascular Congestion in Fatal COVID-19 and Acute Respiratory Distress Syndrome #MMPMID35671465
  • Villalba JA; Hilburn CF; Garlin MA; Elliott GA; Li Y; Kunitoki K; Poli S; Alba GA; Madrigal E; Taso M; Price MC; Aviles AJ; Araujo-Medina M; Bonanno L; Boyraz B; Champion SN; Harris CK; Helland TL; Hutchison B; Jobbagy S; Marshall MS; Shepherd DJ; Barth JL; Hung YP; Ly A; Hariri LP; Turbett SE; Pierce VM; Branda JA; Rosenberg ES; Mendez-Pena J; Chebib I; Rosales IA; Smith RN; Miller MA; Rosas IO; Hardin CC; Baden LR; Medoff BD; Colvin RB; Little BP; Stone JR; Mino-Kenudson M; Shih AR
  • Am J Respir Crit Care Med 2022[Oct]; 206 (7): 857-873 PMID35671465show ga
  • Rationale: The leading cause of death in coronavirus disease 2019 (COVID-19) is severe pneumonia, with many patients developing acute respiratory distress syndrome (ARDS) and diffuse alveolar damage (DAD). Whether DAD in fatal COVID-19 is distinct from other causes of DAD remains unknown. Objective: To compare lung parenchymal and vascular alterations between patients with fatal COVID-19 pneumonia and other DAD-causing etiologies using a multidimensional approach. Methods: This autopsy cohort consisted of consecutive patients with COVID-19 pneumonia (n = 20) and with respiratory failure and histologic DAD (n = 21; non-COVID-19 viral and nonviral etiologies). Premortem chest computed tomography (CT) scans were evaluated for vascular changes. Postmortem lung tissues were compared using histopathological and computational analyses. Machine-learning-derived morphometric analysis of the microvasculature was performed, with a random forest classifier quantifying vascular congestion (C(Vasc)) in different microscopic compartments. Respiratory mechanics and gas-exchange parameters were evaluated longitudinally in patients with ARDS. Measurements and Main Results: In premortem CT, patients with COVID-19 showed more dilated vasculature when all lung segments were evaluated (P = 0.001) compared with controls with DAD. Histopathology revealed vasculopathic changes, including hemangiomatosis-like changes (P = 0.043), thromboemboli (P = 0.0038), pulmonary infarcts (P = 0.047), and perivascular inflammation (P < 0.001). Generalized estimating equations revealed significant regional differences in the lung microarchitecture among all DAD-causing entities. COVID-19 showed a larger overall C(Vasc) range (P = 0.002). Alveolar-septal congestion was associated with a significantly shorter time to death from symptom onset (P = 0.03), length of hospital stay (P = 0.02), and increased ventilatory ratio [an estimate for pulmonary dead space fraction (V(d)); p = 0.043] in all cases of ARDS. Conclusions: Severe COVID-19 pneumonia is characterized by significant vasculopathy and aberrant alveolar-septal congestion. Our findings also highlight the role that vascular alterations may play in V(d) and clinical outcomes in ARDS in general.
  • |*COVID-19/complications[MESH]
  • |*Pneumonia[MESH]
  • |*Respiratory Distress Syndrome/etiology[MESH]
  • |*Vascular Diseases[MESH]
  • |Humans[MESH]
  • |Lung/diagnostic imaging/pathology[MESH]


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