Cargando…

Histopathologic heterogeneity of acute respiratory distress syndrome revealed by surgical lung biopsy and its clinical implications

BACKGROUND/AIMS: Diffuse alveolar damage (DAD) is the histopathologic hallmark of acute respiratory distress syndrome (ARDS). However, there are several non-DAD conditions mimicking ARDS. The purpose of this study was to investigate the histopathologic heterogeneity of ARDS revealed by surgical lung...

Descripción completa

Detalles Bibliográficos
Autores principales: Park, Jimyung, Lee, Yeon Joo, Lee, Jinwoo, Park, Sung Soo, Cho, Young-Jae, Lee, Sang-Min, Kim, Young Whan, Han, Sung Koo, Yoo, Chul-Gyu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Association of Internal Medicine 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5943661/
https://www.ncbi.nlm.nih.gov/pubmed/29088909
http://dx.doi.org/10.3904/kjim.2016.346
_version_ 1783321673175400448
author Park, Jimyung
Lee, Yeon Joo
Lee, Jinwoo
Park, Sung Soo
Cho, Young-Jae
Lee, Sang-Min
Kim, Young Whan
Han, Sung Koo
Yoo, Chul-Gyu
author_facet Park, Jimyung
Lee, Yeon Joo
Lee, Jinwoo
Park, Sung Soo
Cho, Young-Jae
Lee, Sang-Min
Kim, Young Whan
Han, Sung Koo
Yoo, Chul-Gyu
author_sort Park, Jimyung
collection PubMed
description BACKGROUND/AIMS: Diffuse alveolar damage (DAD) is the histopathologic hallmark of acute respiratory distress syndrome (ARDS). However, there are several non-DAD conditions mimicking ARDS. The purpose of this study was to investigate the histopathologic heterogeneity of ARDS revealed by surgical lung biopsy and its clinical relevance. METHODS: We retrospectively analyzed 84 patients with ARDS who met the criteria of the Berlin definition and underwent surgical lung biopsy between January 2004 and December 2013 in three academic hospitals in Korea. We evaluated their histopathologic findings and compared the clinical outcomes. Additionally, the impact of surgical lung biopsy on therapeutic alterations was examined. RESULTS: The histopathologic findings were highly heterogeneous. Of 84 patients undergoing surgical lung biopsy, DAD was observed in 31 patients (36.9%), while 53 patients (63.1%) did not have DAD. Among the non-DAD patients, diffuse interstitial lung diseases and infections were the most frequent histopathologic findings in 19 and 17 patients, respectively. Although the mortality rate was slightly higher in DAD (71.0%) than in non-DAD (62.3%), the difference was not significant. Overall, the biopsy results led to treatment alterations in 40 patients (47.6%). Patients with non-DAD were more likely to change the treatment than those with DAD (58.5% vs. 29.0%), but there were no significant improvements regarding the mortality rate. CONCLUSIONS: The histopathologic findings of ARDS were highly heterogeneous and classic DAD was observed in one third of the patients who underwent surgical lung biopsy. Although therapeutic alterations were more common in patients with non-DAD-ARDS, there were no significant improvements in the mortality rate.
format Online
Article
Text
id pubmed-5943661
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher The Korean Association of Internal Medicine
record_format MEDLINE/PubMed
spelling pubmed-59436612018-05-16 Histopathologic heterogeneity of acute respiratory distress syndrome revealed by surgical lung biopsy and its clinical implications Park, Jimyung Lee, Yeon Joo Lee, Jinwoo Park, Sung Soo Cho, Young-Jae Lee, Sang-Min Kim, Young Whan Han, Sung Koo Yoo, Chul-Gyu Korean J Intern Med Original Article BACKGROUND/AIMS: Diffuse alveolar damage (DAD) is the histopathologic hallmark of acute respiratory distress syndrome (ARDS). However, there are several non-DAD conditions mimicking ARDS. The purpose of this study was to investigate the histopathologic heterogeneity of ARDS revealed by surgical lung biopsy and its clinical relevance. METHODS: We retrospectively analyzed 84 patients with ARDS who met the criteria of the Berlin definition and underwent surgical lung biopsy between January 2004 and December 2013 in three academic hospitals in Korea. We evaluated their histopathologic findings and compared the clinical outcomes. Additionally, the impact of surgical lung biopsy on therapeutic alterations was examined. RESULTS: The histopathologic findings were highly heterogeneous. Of 84 patients undergoing surgical lung biopsy, DAD was observed in 31 patients (36.9%), while 53 patients (63.1%) did not have DAD. Among the non-DAD patients, diffuse interstitial lung diseases and infections were the most frequent histopathologic findings in 19 and 17 patients, respectively. Although the mortality rate was slightly higher in DAD (71.0%) than in non-DAD (62.3%), the difference was not significant. Overall, the biopsy results led to treatment alterations in 40 patients (47.6%). Patients with non-DAD were more likely to change the treatment than those with DAD (58.5% vs. 29.0%), but there were no significant improvements regarding the mortality rate. CONCLUSIONS: The histopathologic findings of ARDS were highly heterogeneous and classic DAD was observed in one third of the patients who underwent surgical lung biopsy. Although therapeutic alterations were more common in patients with non-DAD-ARDS, there were no significant improvements in the mortality rate. The Korean Association of Internal Medicine 2018-05 2017-11-01 /pmc/articles/PMC5943661/ /pubmed/29088909 http://dx.doi.org/10.3904/kjim.2016.346 Text en Copyright © 2018 The Korean Association of Internal Medicine This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Park, Jimyung
Lee, Yeon Joo
Lee, Jinwoo
Park, Sung Soo
Cho, Young-Jae
Lee, Sang-Min
Kim, Young Whan
Han, Sung Koo
Yoo, Chul-Gyu
Histopathologic heterogeneity of acute respiratory distress syndrome revealed by surgical lung biopsy and its clinical implications
title Histopathologic heterogeneity of acute respiratory distress syndrome revealed by surgical lung biopsy and its clinical implications
title_full Histopathologic heterogeneity of acute respiratory distress syndrome revealed by surgical lung biopsy and its clinical implications
title_fullStr Histopathologic heterogeneity of acute respiratory distress syndrome revealed by surgical lung biopsy and its clinical implications
title_full_unstemmed Histopathologic heterogeneity of acute respiratory distress syndrome revealed by surgical lung biopsy and its clinical implications
title_short Histopathologic heterogeneity of acute respiratory distress syndrome revealed by surgical lung biopsy and its clinical implications
title_sort histopathologic heterogeneity of acute respiratory distress syndrome revealed by surgical lung biopsy and its clinical implications
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5943661/
https://www.ncbi.nlm.nih.gov/pubmed/29088909
http://dx.doi.org/10.3904/kjim.2016.346
work_keys_str_mv AT parkjimyung histopathologicheterogeneityofacuterespiratorydistresssyndromerevealedbysurgicallungbiopsyanditsclinicalimplications
AT leeyeonjoo histopathologicheterogeneityofacuterespiratorydistresssyndromerevealedbysurgicallungbiopsyanditsclinicalimplications
AT leejinwoo histopathologicheterogeneityofacuterespiratorydistresssyndromerevealedbysurgicallungbiopsyanditsclinicalimplications
AT parksungsoo histopathologicheterogeneityofacuterespiratorydistresssyndromerevealedbysurgicallungbiopsyanditsclinicalimplications
AT choyoungjae histopathologicheterogeneityofacuterespiratorydistresssyndromerevealedbysurgicallungbiopsyanditsclinicalimplications
AT leesangmin histopathologicheterogeneityofacuterespiratorydistresssyndromerevealedbysurgicallungbiopsyanditsclinicalimplications
AT kimyoungwhan histopathologicheterogeneityofacuterespiratorydistresssyndromerevealedbysurgicallungbiopsyanditsclinicalimplications
AT hansungkoo histopathologicheterogeneityofacuterespiratorydistresssyndromerevealedbysurgicallungbiopsyanditsclinicalimplications
AT yoochulgyu histopathologicheterogeneityofacuterespiratorydistresssyndromerevealedbysurgicallungbiopsyanditsclinicalimplications