Neuropathological Findings in COVID-19 vs non-COVID-19 Acute Respiratory Distress Syndrome - A Case-Control Study

Abstract

Abstract Objective: 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. Design Age and sex matched case-control autopsy study Setting A tertiary academic center Subjects Adult patients with COVID-19 and non-COVID-19 ARDS who died during hospitalization and underwent autopsy. Measurements and Main Results 10 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. Conclusions: Overall, frequency and pattern of ABI in COVID-19 ARDS was comparable to non-COVID-19.