Neuropathological findings in COVID-19 vs. non-COVID-19 acute respiratory distress syndrome-A case-control study

Mariyam Humayun; Lucy Zhang; Thomas D Zaikos; Nivedha Kannapadi; Jose I Suarez; David N Hager; Juan C Troncoso; Sung-Min Cho

doi:10.3389/fneur.2023.1283698

Neuropathological findings in COVID-19 vs. non-COVID-19 acute respiratory distress syndrome-A case-control study

Front Neurol. 2023 Dec 22:14:1283698. doi: 10.3389/fneur.2023.1283698. eCollection 2023.

Authors

Mariyam Humayun¹, Lucy Zhang², Thomas D Zaikos³, Nivedha Kannapadi¹, Jose I Suarez¹, David N Hager⁴, Juan C Troncoso³, Sung-Min Cho¹

Affiliations

¹ Division of Neuroscience Critical Care, Departments of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
² Inova Health System, Falls Church, VA, United States.
³ Neuropathology Division, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
⁴ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.

Abstract

Acute brain injury (ABI) and neuroinflammation is reported in COVID-19 and acute respiratory distress syndrome (ARDS). It remains unclear if COVID-19 plays an independent role in development of ABI compared to those with non-COVID-19 ARDS. We aimed to evaluate if COVID-19 ARDS is associated with higher risk and specific patterns of ABI compared to non-COVID-19 ARDS. We conducted an age and sex matched case-control autopsy study at a tertiary academic center. Ten patients with COVID-19 ARDS were matched to 20 non-COVID-19 ARDS patients. Baseline demographics were comparable between the two groups including severity of ARDS (p = 0.3). The frequency of overall ABI (70 vs. 60%), infratentorial ABI (40 vs. 25%), ischemic infarct (40 vs. 25%), intracranial hemorrhage (30 vs. 35%), and hypoxic-ischemic brain injury (30 vs. 35%) was similar between COVID-19 and non-COVID-19 ARDS patients, respectively (p > 0.05). Intracapillary megakaryocytes were exclusively seen in 30% of COVID-19 patients. Overall, frequency and pattern of ABI in COVID-19 ARDS was comparable to non-COVID-19.

Keywords: COVID-19; acute brain injury; acute respiratory distress syndrome; brain autopsy; neuropathology.

Grants and funding

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.