tetano
Editor, Senior Moderator
J Clin Exp Hepatol
. 2021 Jul 21.
doi: 10.1016/j.jceh.2021.07.004. Online ahead of print.
Evaluation of liver histopathological findings of COVID-19 by minimally invasive autopsies
Vikarn Vishwajeet[SUP] 1 [/SUP], Abhishek Purohit[SUP] 1 [/SUP], Deepak Kumar[SUP] 2 [/SUP], Parag Vijayvergia[SUP] 2 [/SUP], Swapnil Tripathi[SUP] 2 [/SUP], Tanuj Kanchan[SUP] 3 [/SUP], Nikhil Kothari[SUP] 4 [/SUP], Naveen Dutt[SUP] 5 [/SUP], Poonam Abhay Elhence[SUP] 1 [/SUP], Pradeep K Bhatia[SUP] 4 [/SUP], Vijaya Lakshmi Nag[SUP] 6 [/SUP], Mahendra Kumar Garg[SUP] 2 [/SUP], Sanjeev Misra[SUP] 7 [/SUP]
Affiliations
Abstract
Aim: The SARS-CoV-2 outbreak resulted in severe health impact with the loss of many lives across the world. Pulmonary parenchyma suffers most from the brunt of the infection. However, evidence suggested a systemic involvement during the course of illness. Information on morphological changes of liver is sparse in the literature. We aimed to evaluate the pathological findings in liver by minimally invasive autopsies.
Methods: Post-mortem core biopsies of the liver obtained from patients who succumbed to (coronavirus disease 2019) COVID-19 disease were studied. Demographic findings, comorbidities and relevant laboratory tests were collected. Detailed histopathological changes were assessed.
Results: Liver function tests(LFTs) were available in 40 cases, and it was deranged in 80% cases. A spectrum of histological changes was observed. Macrovesicular steatosis and non-specific portal inflammation of mild degree were the common morphological changes. Features suggestive of vascular alteration were noted in more than half of the cases. These included increased portal vein branches, irregular luminal dilation and herniation of portal veins into the periportal hepatocytes. Additionally, we observed morphological changes attributed to terminal shock-related changes.
Conclusion: The present study results highlight that liver parenchyma changes may be related to multiple pathogenic mechanisms. The presence of vascular alteration in portal tracts suggests derangement of hepatic vasculature related to systemic hypercoagulable state induced by the viral infection. It remains to establish if the histological changes are related to direct viral insult or to the systemic response caused by the viral attack.
Keywords: ACE2, Angiotensin-converting enzyme 2; ALT, alanine aminotransferase; ARDS, adult respiratory distress syndrome; AST, aspartate aminotransferase; CBC, complete blood count; CK-MB, creatine kinase-MB; COVID-19; COVID-19, Coronavirus Disease 2019; ISH, in-situ hybridization; LDH, lactate dehydrogenase; LFTs, Liver function tests; PCR, polymerase chain reaction; RNA, ribonucleic acid; SARS-CoV-2; SARS-CoV-2, Severe acute respiratory syndrome corona virus-2; abnormal liver chemistries; autopsy; liver pathology.
. 2021 Jul 21.
doi: 10.1016/j.jceh.2021.07.004. Online ahead of print.
Evaluation of liver histopathological findings of COVID-19 by minimally invasive autopsies
Vikarn Vishwajeet[SUP] 1 [/SUP], Abhishek Purohit[SUP] 1 [/SUP], Deepak Kumar[SUP] 2 [/SUP], Parag Vijayvergia[SUP] 2 [/SUP], Swapnil Tripathi[SUP] 2 [/SUP], Tanuj Kanchan[SUP] 3 [/SUP], Nikhil Kothari[SUP] 4 [/SUP], Naveen Dutt[SUP] 5 [/SUP], Poonam Abhay Elhence[SUP] 1 [/SUP], Pradeep K Bhatia[SUP] 4 [/SUP], Vijaya Lakshmi Nag[SUP] 6 [/SUP], Mahendra Kumar Garg[SUP] 2 [/SUP], Sanjeev Misra[SUP] 7 [/SUP]
Affiliations
- PMID: 34312578
- PMCID: PMC8294712
- DOI: 10.1016/j.jceh.2021.07.004
Abstract
Aim: The SARS-CoV-2 outbreak resulted in severe health impact with the loss of many lives across the world. Pulmonary parenchyma suffers most from the brunt of the infection. However, evidence suggested a systemic involvement during the course of illness. Information on morphological changes of liver is sparse in the literature. We aimed to evaluate the pathological findings in liver by minimally invasive autopsies.
Methods: Post-mortem core biopsies of the liver obtained from patients who succumbed to (coronavirus disease 2019) COVID-19 disease were studied. Demographic findings, comorbidities and relevant laboratory tests were collected. Detailed histopathological changes were assessed.
Results: Liver function tests(LFTs) were available in 40 cases, and it was deranged in 80% cases. A spectrum of histological changes was observed. Macrovesicular steatosis and non-specific portal inflammation of mild degree were the common morphological changes. Features suggestive of vascular alteration were noted in more than half of the cases. These included increased portal vein branches, irregular luminal dilation and herniation of portal veins into the periportal hepatocytes. Additionally, we observed morphological changes attributed to terminal shock-related changes.
Conclusion: The present study results highlight that liver parenchyma changes may be related to multiple pathogenic mechanisms. The presence of vascular alteration in portal tracts suggests derangement of hepatic vasculature related to systemic hypercoagulable state induced by the viral infection. It remains to establish if the histological changes are related to direct viral insult or to the systemic response caused by the viral attack.
Keywords: ACE2, Angiotensin-converting enzyme 2; ALT, alanine aminotransferase; ARDS, adult respiratory distress syndrome; AST, aspartate aminotransferase; CBC, complete blood count; CK-MB, creatine kinase-MB; COVID-19; COVID-19, Coronavirus Disease 2019; ISH, in-situ hybridization; LDH, lactate dehydrogenase; LFTs, Liver function tests; PCR, polymerase chain reaction; RNA, ribonucleic acid; SARS-CoV-2; SARS-CoV-2, Severe acute respiratory syndrome corona virus-2; abnormal liver chemistries; autopsy; liver pathology.