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Background <p>Refractory acute respiratory distress syndrome (ARDS) is the leading cause of death in patients with Covid-19. Large studies of lung pathology in patients who died of Covid-19-ARDS may help to understand the mechanisms of death and to guide further research.</p> Methods <p>This prospective multicentre cohort study included 338 post-mortem, percutaneous, lung biopsies from 169 patients who died of Covid-19-ARDS between 22/04/2020 and 08/03/2021 in 26 intensive care units in France. The biopsies were done at the bedside by the intensivist immediately after death, using a 14G needle and following anatomical landmarks. A pathologist examined all biopsies, describing all elementary lesions and establishing a final histopathological diagnosis.</p> Results <p>Lung parenchyma was evaluable in 155/169 (92%) patients. Early, proliferative-phase diffuse alveolar damage (DAD) was the most common finding (39%), followed by late proliferative-phase DAD (32%) and exudative-phase DAD (18%); fibrotic-phase DAD was present in three (2%) patients. Organising pneumonia (OP) and acute fibrinous and organising pneumonia (AFOP) were evidenced in 21 (13%) and 16 (9%) patients, respectively. Unclassified interstitial lesions were seen in 33 (21%) patients. Microthrombi were uncommon (6%).</p> Conclusions <p>DAD was the most common pathological pattern, whereas collagen fibrosis and microthrombi were rare. A quarter of patients had evidence of OP or AFOP. This substantial prevalence of corticosteroid-sensitive patterns suggests that selected patients with refractory Covid-19-ARDS might benefit from higher doses or longer courses of corticosteroids.</p> <p>Trial registration.</p> <p>ClinicalTrials.gov NCT04675281. Registered 19 December 2020.</p>

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Post-mortem lung biopsies in fatal Covid-19 acute respiratory distress syndrome: a prospective cohort study of 169 patients (HISTOCOVID)

  • 期刊论文

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  • 发表日期：

    2025年6月11日

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  • Jean Morin,
  • Christine Sagan,
  • Morgane Pere,
  • Riad Chelha,
  • Pierre Yves Olivier,
  • Georges Simon,
  • Marion Rougon,
  • Frédéric Pène,
  • Alexis Ferre,
  • Toufik Kamel,
  • Alexandre Boyer,
  • Julio Badie,
  • Jan Hayon,
  • Maxens Decavèle,
  • Pierre Garçon,
  • Jean-Christophe Richard,
  • Laurent Argaud,
  • Sami Hraiech,
  • Johann Auchabie,
  • Camille Foucault,
  • François Legay,
  • Paul-Marie Chanareille,
  • Bertrand Souweine,
  • Guillaume Géri,
  • Agathe Delbove,
  • Vincent Bonny,
  • Pascal Beuret,
  • Damien Vimpere,
  • Gaëtan Plantefève,
  • Emmanuel Canet

摘要

Background

Refractory acute respiratory distress syndrome (ARDS) is the leading cause of death in patients with Covid-19. Large studies of lung pathology in patients who died of Covid-19-ARDS may help to understand the mechanisms of death and to guide further research.

Methods

This prospective multicentre cohort study included 338 post-mortem, percutaneous, lung biopsies from 169 patients who died of Covid-19-ARDS between 22/04/2020 and 08/03/2021 in 26 intensive care units in France. The biopsies were done at the bedside by the intensivist immediately after death, using a 14G needle and following anatomical landmarks. A pathologist examined all biopsies, describing all elementary lesions and establishing a final histopathological diagnosis.

Results

Lung parenchyma was evaluable in 155/169 (92%) patients. Early, proliferative-phase diffuse alveolar damage (DAD) was the most common finding (39%), followed by late proliferative-phase DAD (32%) and exudative-phase DAD (18%); fibrotic-phase DAD was present in three (2%) patients. Organising pneumonia (OP) and acute fibrinous and organising pneumonia (AFOP) were evidenced in 21 (13%) and 16 (9%) patients, respectively. Unclassified interstitial lesions were seen in 33 (21%) patients. Microthrombi were uncommon (6%).

Conclusions

DAD was the most common pathological pattern, whereas collagen fibrosis and microthrombi were rare. A quarter of patients had evidence of OP or AFOP. This substantial prevalence of corticosteroid-sensitive patterns suggests that selected patients with refractory Covid-19-ARDS might benefit from higher doses or longer courses of corticosteroids.

Trial registration.

ClinicalTrials.gov NCT04675281. Registered 19 December 2020.