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Tytuł:
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Progression to fibrosing diffuse alveolar damage in a series of 30 minimally invasive autopsies with COVID-19 pneumonia in Wuhan, China.
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Autorzy:
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Li Y; Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Wu J; Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Wang S; Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Li X; Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Zhou J; Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Huang B; Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Luo D; Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Cao Q; Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Chen Y; Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Chen S; Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Ma L; Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Peng L; Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Pan H; Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Travis WD; Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Nie X; Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Źródło:
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Histopathology [Histopathology] 2021 Mar; Vol. 78 (4), pp. 542-555. Date of Electronic Publication: 2020 Nov 11.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Original Publication: Oxford, Blackwell Scientific Publications.
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MeSH Terms:
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Pandemics*
COVID-19/*complications
Pneumonia/*etiology
Pulmonary Fibrosis/*etiology
SARS-CoV-2/*physiology
Adult ; Aged ; Aged, 80 and over ; Autopsy ; COVID-19/pathology ; COVID-19/virology ; China/epidemiology ; Disease Progression ; Female ; Humans ; Male ; Middle Aged ; Pneumonia/pathology ; Pneumonia/virology ; Pulmonary Fibrosis/pathology ; Pulmonary Fibrosis/virology
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Grant Information:
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P30 CA008748 United States CA NCI NIH HHS; Huazhong University of Science and Technology; 2020YFC0845700 Ministry of Science and Technology; 81773022 National Natural Science Foundation of China
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Contributed Indexing:
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Keywords: COVID-19 pneumonia; SARS-CoV-2; diffuse alveolar damage; fibrosis; lung pathology
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Entry Date(s):
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Date Created: 20200914 Date Completed: 20210222 Latest Revision: 20220302
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Update Code:
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20240105
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PubMed Central ID:
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PMC8848295
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DOI:
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10.1111/his.14249
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PMID:
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32926596
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Aims: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), infection has been deemed as a global pandemic by the World Health Organisation. While diffuse alveolar damage (DAD) is recognised to be the primary manifestation of COVID-19 pneumonia, there has been little emphasis on the progression to the fibrosing phase of DAD. This topic is of great interest, due to growing concerns regarding the potential long-term complications in prolonged survivors.
Methods and Results: Here we report a detailed histopathological study of 30 autopsy cases with COVID-19 virus infection, based on minimally invasive autopsies performed between February and March, 2020. The mean age was 69 years, with 20 (67%) males and 10 (33%) females and frequent (70.0%) underlying comorbidities. The duration of illness ranged from 16 to 82 (median = 42) days. Histologically, the most common manifestation was diffuse alveolar damage (DAD) in 28 (93.3%) cases which showed predominantly acute (32%), organising (25%) and/or fibrosing (43%) patterns. Patients with fibrosing DAD were one decade younger (P = 0.034) and they had a longer duration of illness (P = 0.033), hospitalisation (P = 0.037) and mechanical ventilation (P = 0.014) compared to those with acute DAD. Patients with organising DAD had a longer duration of illness (P = 0.032) and hospitalisation (P = 0.023) compared to those with acute DAD.
Conclusions: COVID-19 pneumonia patients who develop DAD can progress to the fibrosing pattern. While we observed fibrosing DAD in fatal cases, whether or not surviving patients are at risk for developing pulmonary fibrosis and the frequency of this complication will require further clinical and radiological follow-up studies.
(© 2020 John Wiley & Sons Ltd.)
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