Autoptic pulmonary findings have been described in severe COVID-19 patients, but evidence regarding the correlation between clinical picture and lung histopathologic patterns is still weak. This was a retrospective cohort observational study conducted at the referral center for infectious diseases in northern Italy. Full lung autoptic findings and clinical data of patients who died from COVID-19 were analyzed. Lung histopathologic patterns were scored according to the extent of tissue damage. To consider coexisting histopathologic patterns, hierarchical clustering of histopathologic findings was applied. Whole pulmonary examination was available in 75 out of 92 full autopsies. Forty-eight hospitalized patients (64%), 44 from ICU and four from the medical ward, had complete clinical data. The histopathologic patterns had a time-dependent distribution with considerable overlap among patterns. Duration of positive-pressure ventilation (p < 0.0001), mean positive end-expiratory pressure (PEEP) (p = 0.007), worst serum albumin (p = 0.017), interleukin 6 (p = 0.047), and kidney SOFA (p = 0.001) differed among histopathologic clusters. The amount of PEEP for long-lasting ventilatory treatment was associated with the cluster showing the largest areas of early and late proliferative diffuse alveolar damage. No pharmacologic interventions or comorbidities affected the lung histopathology. Our study draws a comprehensive link between the clinical and pulmonary histopathologic findings in a large cohort of COVID-19 patients. These results highlight that the positive end-expiratory pressures and the duration of the ventilatory treatment correlate with lung histopathologic patterns, providing new clues to the knowledge of the pathophysiology of severe SARS-CoV-2 pneumonia.

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严重 COVID-19 中的肺组织病理学集群：临床表现与组织损伤之间的联系

已经在严重的 COVID-19 患者中描述了自体肺的表现，但关于临床表现和肺组织病理学模式之间相关性的证据仍然很弱。这是在意大利北部传染病转诊中心进行的一项回顾性队列观察研究。分析了死于 COVID-19 的患者的全肺自检结果和临床数据。根据组织损伤的程度对肺组织病理学模式进行评分。为了考虑共存的组织病理学模式，应用了组织病理学发现的分层聚类。92 次完整尸检中有 75 次进行了全肺检查。48 名住院患者（64%），其中 44 名来自 ICU，4 名来自内科病房，具有完整的临床数据。组织病理学模式具有时间依赖性分布，模式之间有相当大的重叠。正压通气持续时间 (p < 0.0001)、平均呼气末正压 (PEEP) (p = 0.007)、最差血清白蛋白 (p = 0.017)、白细胞介素 6 (p = 0.047) 和肾脏 SOFA (p = 0.001）在组织病理学簇之间不同。用于长期通气治疗的 PEEP 量与显示早期和晚期增殖性弥漫性肺泡损伤的最大区域的簇相关。没有药物干预或合并症影响肺组织病理学。我们的研究在一大群 COVID-19 患者的临床和肺部组织病理学发现之间建立了全面的联系。