title: Demographic, etiological, and histological pulmonary analysis of patients with acute respiratory failure: a study of 19 years of autopsies.
abstract: BACKGROUND
  Acute respiratory failure has been one of the most important causes of death in intensive care units, and certain aspects of its pulmonary pathology are currently unknown.
  
  
  OBJECTIVE
  The objective was to describe the demographic data, etiology, and pulmonary histopathological findings of different diseases in the autopsies of patients with acute respiratory failure.
  
  
  METHODS
  Autopsies of 4,710 patients with acute respiratory failure from 1990 to 2008 were reviewed, and the following data were obtained: age, sex, and major associated diseases. The pulmonary histopathology was categorized as diffuse alveolar damage, pulmonary edema, alveolar hemorrhage, and lymphoplasmacytic interstitial pneumonia. The odds ratio of the concordance between the major associated diseases and specific autopsy findings was calculated using logistic regression.
  
  
  RESULTS
  Bacterial bronchopneumonia was present in 33.9% of the cases and cancer in 28.1%. The pulmonary histopathology showed diffuse alveolar damage in 40.7% (1,917) of the cases. A multivariate analysis showed a significant and powerful association between diffuse alveolar damage and bronchopneumonia, HIV/AIDS, sepsis, and septic shock, between liver cirrhosis and pulmonary embolism, between pulmonary edema and acute myocardial infarction, between dilated cardiomyopathy and cancer, between alveolar hemorrhage and bronchopneumonia and pulmonary embolism, and between lymphoplasmacytic interstitial pneumonia and HIV/ AIDS and liver cirrhosis.
  
  
  CONCLUSIONS
  Bronchopneumonia was the most common diagnosis in these cases. The most prevalent pulmonary histopathological pattern was diffuse alveolar damage, which was associated with different inflammatory conditions. Further studies are necessary to elucidate the complete pathophysiological mechanisms involved with each disease and the development of acute respiratory failure.
authors.affiliation: Departamento de Cardiopneumologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil. alexandre.soeiro@bol.com.br
authors.forename: Alexandre de Matos
authors.initials: Ade M
authors.lastname: Soeiro
authors.forename: Aline D
authors.initials: AD
authors.lastname: Ruppert
authors.forename: Mauro
authors.initials: M
authors.lastname: Canzian
authors.forename: Edwin R
authors.initials: ER
authors.lastname: Parra
authors.forename: Cecília
authors.initials: C
authors.lastname: Farhat
authors.forename: Vera L
authors.initials: VL
authors.lastname: Capelozzi
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008168:Lung / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000473:pathology*; D017678:Sex Distribution; D012959:Socioeconomic Factors; D055815:Young Adult