Postmortem Liver Pathology Findings in Patients With COVID-19: A Systematic Review
International Journal of Medical Toxicology and Forensic Medicine,
Vol. 11 No. 4 (2021),
17 November 2021
,
Page 35042
https://doi.org/10.32598/ijmtfm.v11i4.35042
Abstract
Background: The Coronavirus Disease 2019 (COVID-19) pandemic promptly became a significant public health challenge with extra-pulmonary manifestations, including liver damage. Postmortem examination is crucial for gaining a better understanding of these manifestations and improving patient management. This study summarized the current knowledge of the postmortem liver pathology of patients with COVID-19.
Methods: This review was conducted on studies evaluating the postmortem macroscopic and microscopic findings of the liver in patients with COVID-19. Accordingly, we searched 4 electronic databases (PubMed, Scopus, Google Scholar, & Web of Science) until June 2021. From the 317 screened articles, 16 articles examining a total of 332 patients who had died due to COVID-19 were selected.
Results: The significant findings of the liver were moderate macro and microvesicular steatosis with mild sinusoidal dilation, active lobular and portal vein thrombosis, mildly-increased lymphocyte filtration in sinusoidal space, and multifocal hepatic necrosis. Additionally, the most common comorbidities were hypertension and other metabolic diseases. In conclusion, liver damage due to COVID-19 infection has various manifestations in patients who have expired due to COVID-19.
Conclusion: Therefore, monitoring liver function during the course and treatment of this disease is necessary for better patient management and to decrease the COVID-19-induced mortality rate COVID.
- Postmortem
- Findings
- Liver
- Pathology
- Coronavirus Disease 2019 (COVID-19)
How to Cite
References
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet. 2020; 395(10223):507-13. [DOI:10.1016/S0140-6736(20)30211-7]
World Health Organization (WHO). Listings of WHO's response to COVID-19; Accessed 21 Dec 2020. https://www.who.int/news/item/29-06-2020-covid timeline
Sohrabi C, Alsafi Z, O’Neill N, Khan M, Kerwan A, Al-Jabir A, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg. 2020; 76:71-6. [DOI:10.1016/j.ijsu.2020.02.034] [PMID] [PMCID]
Besharat S, Malekpour Alamda N, Dadashzadeh N, Talaie R, Mousavi SS, Barzegar A, et al. Clinical and demographic characteristics of patients with COVID-19 who died in Modarres Hospital. Maced J Med Sci. 2020; 8(T1):144-9. [DOI:10.3889/oamjms.2020.5013]
Keten D, Okdemir E, Keten A. Precautions in postmortem examinations in Covid-19 - Related deaths: Recommendations from Germany. J Forensic Leg Med. 2020; 73:102000. [DOI:10.1016/j.jflm.2020.102000] [PMID] [PMCID]
Docherty AB, Harrison EM, Green CA, Hardwick HE, Pius R, Norman L, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: Prospective observational cohort study. BMJ (Clinical research ed). 2020; 369:m1985. [DOI:10.1136/bmj.m1985] [PMID] [PMCID]
Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020; 180(7):934-43. [DOI:10.1001/jamainternmed.2020.0994] [PMID] [PMCID]
Cummings MJ, Baldwin MR, Abrams D, Jacobson SD, Meyer BJ, Balough EM, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: A prospective cohort study. Lancet. 2020; 395(10239):1763-70. [DOI:10.1016/S0140-6736(20)31189-2]
Daneshvar M, Dadashzadeh N, Ahmadpour M, Ragati Haghi H, Rahmani V, Frouzesh M, et al. Lessons of mortality following COVID-19 epidemic in the United States especially in the geriatrics. J Nephropharmacol. 2021; 10(1):e06. [DOI:10.34172/npj.2021.06]
Xu L, Liu J, Lu M, Yang D, Zheng X. Liver injury during highly pathogenic human coronavirus infections. Liver Int. 2020; 40(5):998-1004. [DOI:10.1111/liv.14435] [PMID] [PMCID]
Zhang Y, Zheng L, Liu L, Zhao M, Xiao J, Zhao Q. Liver impairment in COVID-19 patients: A retrospective analysis of 115 cases from a single centre in Wuhan city, China. Liver Int. 2020; 40(9):2095-103. [DOI:10.1111/liv.14455] [PMID]
Li Y, Xiao SY. Hepatic involvement in COVID-19 patients: Pathology, pathogenesis, and clinical implications. J Med Virol. 2020; 92(9):1491-4. [DOI:10.1002/jmv.25973] [PMID]
Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: A descriptive study. Lancet Infect Dis. 2020; 20(4):425-34. [DOI:10.1016/S1473-3099(20)30086-4] [PMID]
Bangash MN, Patel J, Parekh D. COVID-19 and the liver: Little cause for concern. Lancet Gastroenterol Hepatol. 2020; 5(6):529-30. [DOI:10.1016/S2468-1253(20)30084-4] [PMID]
Chai X, Hu L, Zhang Y, Han W, Lu Z, Ke A, et al. Specific ACE2 expression in cholangiocytes may cause liver damage after 2019-nCoV infection. bioRxiv. 2020. [DOI:10.1101/2020.02.03.931766]
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration. BMJ. 2009; 339:b2700. [DOI:10.1136/bmj.b2700] [PMID] [PMCID]
Murad MH, Sultan S, Haffar S, Bazerbachi F. Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med. 2018; 23(2):60-3. [DOI:10.1136/bmjebm-2017-110853] [PMID] [PMCID]
Sadegh Beigee F, Pourabdollah Toutkaboni M, Khalili N, Nadji SA, Dorudinia A, Rezaei M, et al. Diffuse alveolar damage and thrombotic microangiopathy are the main histopathological findings in lung tissue biopsy samples of COVID-19 patients. Pathol Res Pract. 2020; 216(10):153228. [DOI:10.1016/j.prp.2020.153228] [PMID] [PMCID]
Beigmohammadi MT, Jahanbin B, Safaei M, Amoozadeh L, Khoshavi M, Mehrtash V, et al. Pathological findings of postmortem biopsies from lung, heart, and liver of 7 deceased COVID-19 patients. Int J Surg Pathol. 2021; 29(2):135-45. [DOI:10.1177/1066896920935195] [PMID] [PMCID]
Bradley BT, Maioli H, Johnston R, Chaudhry I, Fink SL, Xu H, et al. Histopathology and ultrastructural findings of fatal COVID-19 infections in Washington State: A case series. Lancet. 2020; 396(10247):320-32. [DOI:10.1016/S0140-6736(20)31305-2] [PMID]
Buja LM, Wolf DA, Zhao B, Akkanti B, McDonald M, Lelenwa L, et al. The emerging spectrum of cardiopulmonary pathology of the coronavirus disease 2019 (COVID-19): Report of 3 autopsies from Houston, Texas, and review of autopsy findings from other United States cities. Cardiovasc Pathol. 2020; 48:107233. [DOI:10.1016/j.carpath.2020.107233] [PMID] [PMCID]
Duarte-Neto AN, Monteiro RAA, da Silva LFF, Malheiros DMAC, de Oliveira EP, Theodoro-Filho J, et al. Pulmonary and systemic involvement in COVID-19 patients assessed with ultrasound-guided minimally invasive autopsy. Histopathology. 2020; 77(2):186-97. [DOI:10.1111/his.14160] [PMID] [PMCID]
Elsoukkary SS, Mostyka M, Dillard A, Berman DR, Ma LX, Chadburn A, et al. Autopsy findings in 32 patients with COVID-19: A single-institution experience. Pathobiology. 2021; 88(1):56-68. [DOI:10.1159/000511325] [PMID] [PMCID]
Falasca L, Nardacci R, Colombo D, Lalle E, Di Caro A, Nicastri E, et al. Postmortem findings in Italian patients with COVID-19: A descriptive full autopsy study of cases with and without comorbidities. J Infect Dis. 2020; 222(11):1807-15. [DOI:10.1093/infdis/jiaa578] [PMID] [PMCID]
Rapkiewicz AV, Mai X, Carsons SE, Pittaluga S, Kleiner DE, Berger JS, et al. Megakaryocytes and platelet-fibrin thrombi characterize multi-organ thrombosis at autopsy in COVID-19: A case series. EClinicalMedicine. 2020; 24:100434. [DOI:10.1016/j.eclinm.2020.100434] [PMID] [PMCID]
Remmelink M, De Mendonça R, D’Haene N, De Clercq S, Verocq C, Lebrun L, et al. Unspecific post-mortem findings despite multiorgan viral spread in COVID-19 patients. Crit Care. 2020; 24(1):495. [DOI:10.1186/s13054-020-03218-5] [PMID] [PMCID]
Schmit G, Lelotte J, Vanhaebost J, Horsmans Y, Van Bockstal M, Baldin P. The liver in COVID-19-related death: Protagonist or innocent bystander? Pathobiology. 2021; 88(1):88-94. [DOI:10.1159/000512008] [PMID] [PMCID]
Sonzogni A, Previtali G, Seghezzi M, Grazia Alessio M, Gianatti A, Licini L, et al. Liver histopathology in severe COVID 19 respiratory failure is suggestive of vascular alterations. Liver Int. 2020; 40(9):2110-6. [DOI:10.1111/liv.14601] [PMID] [PMCID]
Wichmann D, Sperhake JP, Lütgehetmann M, Steurer S, Edler C, Heinemann A, et al. Autopsy findings and venous thromboembolism in patients with COVID-19: A prospective cohort study. Ann Intern Med. 2020; 173(4):268-77. [DOI:10.7326/M20-2003] [PMID] [PMCID]
Zhao CL, Rapkiewicz A, Maghsoodi-Deerwester M, Gupta M, Cao W, Palaia T, et al. Pathological findings in the postmortem liver of patients with coronavirus disease 2019 (COVID-19). Hum Pathol. 2021; 109:59-68. [DOI:10.1016/j.humpath.2020.11.015] [PMID] [PMCID]
Schurink B, Roos E, Radonic T, Barbe E, Bouman CSC, de Boer HH, et al. Viral presence and immunopathology in patients with lethal COVID-19: A prospective autopsy cohort study. Lancet Microbe. 2020; 1(7):e290-9. [DOI:10.1016/S2666-5247(20)30144-0]
Lagana SM, Kudose S, Iuga AC, Lee MJ, Fazlollahi L, Remotti HE, et al. Hepatic pathology in patients dying of COVID-19: A series of 40 cases including clinical, histologic, and virologic data. Mod Pathol. 2020; 33(11):2147-55. [DOI:10.1038/s41379-020-00649-x] [PMID] [PMCID]
Fassan M, Mescoli C, Sbaraglia M, Guzzardo V, Russo FP, Fabris R, et al. Liver histopathology in COVID-19 patients: A mono-Institutional series of liver biopsies and autopsy specimens. Pathol Res Pract. 2021; 221:153451. [DOI:10.1016/j.prp.2021.153451] [PMID] [PMCID]
Tombolini A, Scendoni R. SARS-CoV-2-related deaths in routine forensic autopsy practice: Histopathological patterns. Int J Legal Med. 2020; 134(6):2205-8. [DOI:10.1007/s00414-020-02354-5] [PMID] [PMCID]
Ledford H. Autopsy slowdown hinders quest to determine how coronavirus kills. Nature. 2020. [DOI:10.1038/d41586-020-01355-z] [PMID]
Zhang C, Shi L, Wang FS. Liver injury in COVID-19: Management and challenges. Lancet Gastroenterol Hepatol. 2020; 5(5):428-30. [DOI:10.1016/S2468-1253(20)30057-1]
Fan Z, Chen L, Li J, Cheng X, Yang J, Tian C, et al. Clinical features of COVID-19-related liver functional abnormality. Clin Gastroenterol Hepatol. 2020; 18(7):1561-6. [DOI:10.1016/j.cgh.2020.04.002] [PMID] [PMCID]
Cai Q, Huang D, Yu H, Zhu Z, Xia Z, Su Y, et al. COVID-19: Abnormal liver function tests. J Hepatol. 2020; 73(3):566-74. [DOI: 10.1016/j.jhep.2020.04.006] [PMID] [PMCID]
Martines RB, Ritter JM, Matkovic E, Gary J, Bollweg BC, Bullock H, et al. Pathology and pathogenesis of SARS-CoV-2 associated with fatal coronavirus disease, United States. Emerg Infect Dis. 2020; 26(9):2005-15. [DOI:10.3201/eid2609.202095] [PMID] [PMCID]
Milroy CM. Fatty liver and the forensic pathologist. Acad Forensic Pathol. 2018; 8(2):296-310. [DOI:10.1177/1925362118782061] [PMID] [PMCID]
D’Amico F, Baumgart DC, Danese S, Peyrin-Biroulet L. Diarrhea during COVID-19 infection: Pathogenesis, epidemiology, prevention, and management. Clin Gastroenterol Hepatol. 2020; 18(8):1663-72. [DOI:10.1016/j.cgh.2020.04.001] [PMID] [PMCID]
Nobel YR, Phipps M, Zucker J, Lebwohl B, Wang TC, Sobieszczyk ME, et al. Gastrointestinal symptoms and coronavirus disease 2019: A case-control study from the United States. Gastroenterology. 2020; 159(1):373-5.e2. [DOI:10.1053/j.gastro.2020.04.017] [PMID] [PMCID]
Eketunde AO, Mellacheruvu SP, Oreoluwa P. a review of postmortem findings in patients with COVID-19. Cureus. 2020; 12(7):e9438. [DOI:10.7759/cureus.9438]
Lax SF, Skok K, Zechner P, Kessler HH, Kaufmann N, Koelblinger C, et al. Pulmonary arterial thrombosis in COVID-19 with fatal outcome: Results from a prospective, single-center, clinicopathologic case series. Ann Intern Med. 2020; 173(5):350-61. [DOI:10.7326/M20-2566] [PMID] [PMCID]
Jothimani D, Venugopal R, Abedin MF, Kaliamoorthy I, Rela M. COVID-19 and the liver. J Hepatol. 2020; 73(5):1231-40. [DOI:10.1016/j.jhep.2020.06.006] [PMID] [PMCID]
Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, Ji R, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: A systematic review and meta-analysis. Int J Infect Dis. 2020; 94:91-5. [DOI:10.1016/j.ijid.2020.03.017] [PMID] [PMCID]
Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: Retrospective study. BMJ. 2020; 368:m1091. [DOI:10.1136/bmj.m1091] [PMID] [PMCID]
- Abstract Viewed: 431 times
- pdf Downloaded: 233 times