A Case-Control Autopsy Series of Liver Pathology Associated with Novel Coronavirus Disease (COVID-19)

ABSTRACT

Background: COVID-19, the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to be a global health emergency. Although well-known for pulmonary injury, COVID-19 is a systemic process. Previous autopsy case series have speculated about, although not clearly defined, patterns of hepatic injury, with steatosis being reported in many patients. This retrospective study is the first case-control study investigating hepatic pathology in a large cohort of deceased COVID-19 patients. Design: Consented autopsy cases at two institutions, between 4/2020 and 2/2021, were retrospectively searched for documentation of COVID-19 as a contributing cause of death. A control group of 40 consecutive consented COVID-19(-) autopsy cases during the same period was identified. The autopsy report and electronic medical records were reviewed for clinical information. H&E-stained liver sections were examined for selected histologic features. Results: 54 COVID-19(+) (mean age 72, MF=3.21) were included in the study. The 40 control cases had a mean age of 64 years and a MF=1.41. The study group was significantly older (p=0.0095) but there was no significant difference in sex. The control group had a higher rate of chronic alcoholism and underlying malignancy, with no difference noted in BMI or other comorbidities. The study group was more likely to have received steroid (72.2% vs. 30%, p<0.0001) and anticoagulation therapy (75.9% vs. 47.5%, p=0.009). Histologically, the study group showed a higher incidence of clinically insignificant steatosis (≤5%), (33.3% vs 12.5%;P = 0.03). Presence of clinically relevant (>5%) steatosis or zonal distribution of steatosis was not significantly different between the groups. Mild nonspecific lobular inflammation and acidophil bodies were also more common in COVID-19 cases (51.9% vs 30.0%;P = 0.04). No significant difference was noted among other histologic features, including vascular changes (Table 1). Conclusions: Mild nonspecific lobular necroinflammatory activity is a common finding in deceased COVID-19 patients, suggestive of COVID-19 hepatitis. COVID-19 is unlikely a cause of clinically significant steatosis. However, patients with COVID-19 are more likely to have low levels of steatosis (≤5%) compared to controls. The high rate of steroid therapy in this population may be a possible source of this minor component of steatosis.