Pulmonary histopathological alterations in patients with acute respiratory failure: an autopsy study.
OBJECTIVE
To present the pulmonary histopathological alterations found in the autopsies of patients with acute respiratory failure (ARF) and determine whether underlying diseases and certain associated risk factors increase the incidence of these histopathological patterns.


METHODS
Final autopsy reports were reviewed, and 3030 autopsies of patients > 1 year of age with an underlying disease and associated risk factors were selected. All had developed diffuse infiltrates and died of ARF-related pulmonary alterations.


RESULTS
The principal pulmonary histopathological alterations resulting in immediate death were diffuse alveolar damage (DAD), pulmonary edema, lymphocytic interstitial pneumonia (LIP) and alveolar hemorrhage. The principal underlying diseases were AIDS, bronchopneumonia, sepsis, liver cirrhosis, pulmonary thromboembolism, acute myocardial infarction (AMI), cerebrovascular accident, tuberculosis, cancer, chronic kidney failure and leukemia. The principal associated risk factors were as follows: age > 50 years; arterial hypertension; congestive heart failure; chronic obstructive pulmonary disease; and diabetes mellitus. These risk factors and AIDS correlated with a high risk of developing LIP; these same risk factors, if concomitant with sepsis or liver cirrhosis, correlated with a risk of developing DAD; thromboembolism and these risk factors correlated with a risk of developing alveolar hemorrhage; these risk factors and AMI correlated with a risk of developing pulmonary edema.


CONCLUSIONS
Pulmonary findings in patients who died of ARF presented four histopathological patterns: DAD, pulmonary edema, LIP and alveolar hemorrhage. Underlying diseases and certain associated risk factors correlated positively with specific histopathological findings on autopsy.
Soeiro
Alexandre de Matos
Ade M
Faculdade de Medicina da Universidade de São Paulo - FMUSP, University of São Paulo School of Medicine, São Paulo, Brazil.
Parra
Edwin Roger
ER
Canzian
Mauro
M
Farhat
Cecília
C
Capelozzi
Vera Luiza
VL
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D001706:Biopsy; D002648:Child; D006470:Hemorrhage / Q000473:pathology; D006801:Humans; D016015:Logistic Models; D008168:Lung / Q000473:pathology*; D008171:Lung Diseases / Q000209:etiology / Q000473:pathology*; D017563:Lung Diseases, Interstitial / Q000473:pathology; D008875:Middle Aged; D016017:Odds Ratio; D011654:Pulmonary Edema / Q000473:pathology; D012131:Respiratory Insufficiency / Q000209:etiology / Q000473:pathology*; D012307:Risk Factors