Evidence for a thromboembolic pathogenesis of lung cavitations in severely ill COVID-19 patients

Abstract Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) induces lung injury of varying severity, potentially causing severe acute respiratory distress syndrome (ARDS). Pulmonary injury patterns in COVID-19 patients differ from those in patien...

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Autores principales:	Jan Matthias Kruse, Daniel Zickler, Willie M. Lüdemann, Sophie K. Piper, Inka Gotthardt, Jana Ihlow, Selina Greuel, David Horst, Andreas Kahl, Kai-Uwe Eckardt, Sefer Elezkurtaj
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/2b1cbf31a5a947619e2f08ce4ee8cea0
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spelling	oai:doaj.org-article:2b1cbf31a5a947619e2f08ce4ee8cea02021-12-02T16:35:19ZEvidence for a thromboembolic pathogenesis of lung cavitations in severely ill COVID-19 patients10.1038/s41598-021-95694-02045-2322https://doaj.org/article/2b1cbf31a5a947619e2f08ce4ee8cea02021-08-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-95694-0https://doaj.org/toc/2045-2322Abstract Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) induces lung injury of varying severity, potentially causing severe acute respiratory distress syndrome (ARDS). Pulmonary injury patterns in COVID-19 patients differ from those in patients with other causes of ARDS. We aimed to explore the frequency and pathogenesis of cavitary lung lesions in critically ill patients with COVID-19. Retrospective study in 39 critically ill adult patients hospitalized with severe acute respiratory syndrome coronavirus 2 including lung injury of varying severity in a tertiary care referral center during March and May 2020, Berlin/Germany. We observed lung cavitations in an unusually large proportion of 22/39 (56%) COVID-19 patients treated on intensive care units (ICU), including 3/5 patients without mechanical ventilation. Median interquartile range (IQR) time between onset of symptoms and ICU admission was 11.5 (6.25–17.75) days. In 15 patients, lung cavitations were already present on the first CT scan, performed after ICU admission; in seven patients they developed during a subsequent median (IQR) observation period of 48 (35–58) days. In seven patients we found at least one cavitation with a diameter > 2 cm (maximum 10 cm). Patients who developed cavitations were older and had a higher body mass index. Autopsy findings in three patients revealed that the cavitations reflected lung infarcts undergoing liquefaction, secondary to thrombotic pulmonary artery branch occlusions. Lung cavitations appear to be a frequent complication of severely ill COVID-19 patients, probably related to the prothrombotic state associated with COVID-19.Jan Matthias KruseDaniel ZicklerWillie M. LüdemannSophie K. PiperInka GotthardtJana IhlowSelina GreuelDavid HorstAndreas KahlKai-Uwe EckardtSefer ElezkurtajNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Jan Matthias Kruse Daniel Zickler Willie M. Lüdemann Sophie K. Piper Inka Gotthardt Jana Ihlow Selina Greuel David Horst Andreas Kahl Kai-Uwe Eckardt Sefer Elezkurtaj Evidence for a thromboembolic pathogenesis of lung cavitations in severely ill COVID-19 patients
description	Abstract Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) induces lung injury of varying severity, potentially causing severe acute respiratory distress syndrome (ARDS). Pulmonary injury patterns in COVID-19 patients differ from those in patients with other causes of ARDS. We aimed to explore the frequency and pathogenesis of cavitary lung lesions in critically ill patients with COVID-19. Retrospective study in 39 critically ill adult patients hospitalized with severe acute respiratory syndrome coronavirus 2 including lung injury of varying severity in a tertiary care referral center during March and May 2020, Berlin/Germany. We observed lung cavitations in an unusually large proportion of 22/39 (56%) COVID-19 patients treated on intensive care units (ICU), including 3/5 patients without mechanical ventilation. Median interquartile range (IQR) time between onset of symptoms and ICU admission was 11.5 (6.25–17.75) days. In 15 patients, lung cavitations were already present on the first CT scan, performed after ICU admission; in seven patients they developed during a subsequent median (IQR) observation period of 48 (35–58) days. In seven patients we found at least one cavitation with a diameter > 2 cm (maximum 10 cm). Patients who developed cavitations were older and had a higher body mass index. Autopsy findings in three patients revealed that the cavitations reflected lung infarcts undergoing liquefaction, secondary to thrombotic pulmonary artery branch occlusions. Lung cavitations appear to be a frequent complication of severely ill COVID-19 patients, probably related to the prothrombotic state associated with COVID-19.
format	article
author	Jan Matthias Kruse Daniel Zickler Willie M. Lüdemann Sophie K. Piper Inka Gotthardt Jana Ihlow Selina Greuel David Horst Andreas Kahl Kai-Uwe Eckardt Sefer Elezkurtaj
author_facet	Jan Matthias Kruse Daniel Zickler Willie M. Lüdemann Sophie K. Piper Inka Gotthardt Jana Ihlow Selina Greuel David Horst Andreas Kahl Kai-Uwe Eckardt Sefer Elezkurtaj
author_sort	Jan Matthias Kruse
title	Evidence for a thromboembolic pathogenesis of lung cavitations in severely ill COVID-19 patients
title_short	Evidence for a thromboembolic pathogenesis of lung cavitations in severely ill COVID-19 patients
title_full	Evidence for a thromboembolic pathogenesis of lung cavitations in severely ill COVID-19 patients
title_fullStr	Evidence for a thromboembolic pathogenesis of lung cavitations in severely ill COVID-19 patients
title_full_unstemmed	Evidence for a thromboembolic pathogenesis of lung cavitations in severely ill COVID-19 patients
title_sort	evidence for a thromboembolic pathogenesis of lung cavitations in severely ill covid-19 patients
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/2b1cbf31a5a947619e2f08ce4ee8cea0
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Evidence for a thromboembolic pathogenesis of lung cavitations in severely ill COVID-19 patients

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