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Published on: August 4, 2012
The Liver in COVID-19-Related Death: Protagonist or Innocent Bystander?
Grégory Schmit1,2, Julie Lelotte3,4, Jessica Vanhaebost5,3
1Center of Forensic Medicine, Department of Pathology, Cliniques Universitaires Saint-Luc, Brussels, Belgium, gregory.schmit@uclouvain.be.
Introduction:
The coronavirus disease 2019 (COVID-19) infection, caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), involves several organs through participation of angiotensin-conversion enzyme 2 (ACE2) receptors. The presence of ACE2 receptors in the liver renders this organ a potential target for the novel coronavirus.
Methods:
We performed 14 complete autopsies of patients infected with SARS-CoV-2. In each case we stained liver tissue sections with haematoxylin/eosin, Masson blue trichrome stain, periodic acid-Schiff (PAS), Perls, and performed cytokeratin-7 (CK7) immunochemistry.
Results:
Macroscopically, livers were pale and yellowish in 8 of 14 (57%) patients, and had a nutmeg appearance in the other 6 cases (42%). Histologically, centrolobular necrosis was observed in 12 cases (86%), and was associated with discreet to moderate lobular or portal inflammation. Steatosis was seen in 8 cases (57%), but fibrosis was rare. Cholestasis and discrete bile duct proliferation was observed in 5 cases (36%).
Discussion/Conclusion:
The main histological changes can be explained by the hypoxic status as a result of severe hypoxemic pneumonia leading to death. Drug toxicity may also play a role in certain cases. Other histological changes may be explained by previous hepatic conditions or underlying hepatic diseases. We concluded that COVID-19 infection was not associated with a specific histopathological pattern of the liver.
Insights
COVID-19 infection did not cause a specific liver histopathology pattern. Observed liver changes in patients were likely due to hypoxia from pneumonia or other pre-existing conditions.
Area of Science:
- Pathology
- Hepatology
- Infectious Diseases
Background:
- Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, affects multiple organs.
- The liver is a potential target due to angiotensin-converting enzyme 2 (ACE2) receptor expression.
Purpose of the Study:
- To investigate the histopathological changes in the liver of patients with COVID-19.
Main Methods:
- Performed 14 autopsies on SARS-CoV-2 infected patients.
- Examined liver tissue using H&E, Masson trichrome, PAS, Perls stains, and CK7 immunohistochemistry.
Main Results:
- Macroscopic findings included pale/yellowish livers (57%) and nutmeg appearance (42%).
- Histological findings showed centrolobular necrosis (86%), steatosis (57%), cholestasis (36%), and rare fibrosis.
- Inflammation was observed in lobular or portal areas.
Conclusions:
- Histological changes are likely attributed to hypoxia from severe pneumonia.
- Drug toxicity and pre-existing liver conditions may also contribute to observed changes.
- COVID-19 infection is not associated with a distinct liver histopathological pattern.
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