Abstract
Although the pathologic investigation of liver injury was observed in a couple of cases in China, the detailed description of liver histopathologic and ultrastructural changes in a relatively larger series of liver tissues from COVID-19 patients is lacking. Samples from the liver were obtained from 24 COVID-19 cases from February 1 to April 1, 2020. Light microscopy showed that all liver sections had different degrees of liver injury manifested as swelling of the hepatocytes, hepatocellular necrosis, steatosis, lobular inflammation, portal inflammation, dilatation of sinusoids, and so on. SARS-CoV-2 induced liver injury might be independent of pre-existing Schistosoma infection or obstructive cholestasis. Patients combined with respiratory failure had more severe hepatocellular necrosis and male patients were more susceptible to liver injury. Although coronavirus particles or viral inclusions were not detected in the liver tissues for all cases, vacuolar degenerations in hepatocytes, edematous of mitochondria with the disruption of cristae, and expansions of the endoplasmic reticulum were observed. In conclusion, pathologic changes of liver tissues provide us a further understanding of liver injury in COVID-19 patients. Changes in the liver seem to be related to the underlying diseases/conditions.
Highlights
The Corona Virus Disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), has been considered as a public health emergency of international concern by the World Health Organization (WHO)
One case combined with obstructive cholestasis presented with moderate swelling of the hepatocytes, moderate cholestasis, and mild hepatocellular necrosis (Table 4). These results indicated that SARS-CoV-2 induced liver injury might be independent of pre-existing Schistosoma infection or obstructive cholestasis
We report the liver histopathologic, ultrastructural, and reverse-transcriptase polymerasechain-reaction (RT-PCR) findings from biopsies of 24 patients who died from respiratory failure or circulatory failure due to COVID-19
Summary
The Corona Virus Disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), has been considered as a public health emergency of international concern by the World Health Organization (WHO). COVID-19 mainly affects the lower respiratory tract. It induces acute kidney injury and liver dysfunction in some patients [2,3,4,5]. On the basis of previous reports from China, a subset of COVID-19 patients had liver impairment with abnormal levels of alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) accompanied by slightly elevated bilirubin levels during disease progression [6,7,8]. The incidence of liver injury in COVID-19 patients was
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