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
{"title":"致死性Covid-19急性呼吸窘迫综合征的死后肺活检：169例患者的前瞻性队列研究（HISTOCOVID）。","authors":"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","doi":"10.1186/s13613-025-01493-5","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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><p><strong>Methods: </strong>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><p><strong>Results: </strong>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><p><strong>Conclusions: </strong>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><strong>Trial registration: </strong></p><p><strong>Clinicaltrials: </strong>gov NCT04675281. Registered 19 December 2020.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"80"},"PeriodicalIF":5.7000,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12158891/pdf/","citationCount":"0","resultStr":"{\"title\":\"Post-mortem lung biopsies in fatal Covid-19 acute respiratory distress syndrome: a prospective cohort study of 169 patients (HISTOCOVID).\",\"authors\":\"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\",\"doi\":\"10.1186/s13613-025-01493-5\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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><p><strong>Methods: </strong>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><p><strong>Results: </strong>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><p><strong>Conclusions: </strong>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><strong>Trial registration: </strong></p><p><strong>Clinicaltrials: </strong>gov NCT04675281. 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Post-mortem lung biopsies in fatal Covid-19 acute respiratory distress syndrome: a prospective cohort study of 169 patients (HISTOCOVID).
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.
期刊介绍：
Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
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