Diaphragm Pathology in Critically Ill Patients With COVID-19 and Postmortem Findings From 3 Medical Centers

Abstract

This case-control study examines the association of COVID-19 with the respiratory muscles in Dutch critically ill patients.

Conflict of interest statement

Conflict of Interest Disclosures: Dr de Vries reported grants from Amsterdam Cardiovascular Sciences during the conduct of the study and personal fees from a Dutch ultrasound center outside the submitted work. Dr Heunks reported personal fees from Getinge and grants from Liberate Medical outside the submitted work. No other disclosures were reported.

Figures

Figure.. Angiotensin-Converting Enzyme 2 (ACE-2), SARS-CoV-2, and Fibrosis in the Diaphragms of Patients With COVID-19

A, Left panel: ACE-2 mRNA in diaphragm specimens determined by quantitative polymerase chain reaction (qPCR) and normalized to housekeeping gene TBP. Right panel: α-ACE-2 antibody localization with fluoresceine microscopy on diaphragm cross-sections; the arrowheads show membrane and cytosolic localization (bar = 50 μm). B, Left panel: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral RNA, determined by qPCR and normalized to housekeeping gene TBP, is detected in the diaphragm of 4 coronavirus disease 2019 (COVID-19)–intensive care unit (ICU) patients (patients 7, 9, 33, and 36). Right panel: in situ hybridization using RNAscope on patient #7 shows intramyofiber SARS-CoV-2 virus particles (red dots, indicated with arrowheads); a myofiber edge is highlighted with dashed line (bar = 30 μm). C, Left panels: representative images of picrosirius red-stained diaphragm cross-sections to highlight fibrosis; patients #22 and 3 are shown (bar = 100 μm). Right panel: quantification of the amount of fibrosis.