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http://dx.doi.org/10.3904/kjim.2016.346

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

Park, Jimyung (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital)
Lee, Yeon Joo (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital)
Lee, Jinwoo (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital)
Park, Sung Soo (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center)
Cho, Young-Jae (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital)
Lee, Sang-Min (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital)
Kim, Young Whan (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital)
Han, Sung Koo (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital)
Yoo, Chul-Gyu (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital)
Publication Information
The Korean journal of internal medicine / v.33, no.3, 2018 , pp. 532-540 More about this Journal
Abstract
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.
Keywords
Acute lung injury; Biopsy; Pathology; Respiratory distress syndrome; adult;
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