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SARS-CoV-2 infection of the liver directly contributes to hepatic impairment in patients with COVID-19.
Wang, Yijin; Liu, Shuhong; Liu, Hongyang; Li, Wei; Lin, Fang; Jiang, Lina; Li, Xi; Xu, Pengfei; Zhang, Lixin; Zhao, Lihua; Cao, Yun; Kang, Jiarui; Yang, Jianfa; Li, Ling; Liu, Xiaoyan; Li, Yan; Nie, Ruifang; Mu, Jinsong; Lu, Fengmin; Zhao, Shousong; Lu, Jiangyang; Zhao, Jingmin.
  • Wang Y; Department of Pathology and Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
  • Liu S; Department of Pathology and Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
  • Liu H; Department of Pathology and Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
  • Li W; Department of Infectious Diseases, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China.
  • Lin F; Department of Intensive Care Unit, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
  • Jiang L; Department of Pathology and Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
  • Li X; Department of Pathology and Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
  • Xu P; Department of Pathology and Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
  • Zhang L; Department of Pathology and Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
  • Zhao L; Department of Pathology and Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
  • Cao Y; Department of Infectious Diseases, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China.
  • Kang J; Department of Pathology, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.
  • Yang J; Department of Pathology and Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
  • Li L; Department of Pathology and Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
  • Liu X; Department of Pathology and Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
  • Li Y; Department of Pathology and Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
  • Nie R; Department of Pathology and Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
  • Mu J; Department of Intensive Care Unit, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
  • Lu F; Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China.
  • Zhao S; Department of Infectious Diseases, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China.
  • Lu J; Department of Pathology, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.
  • Zhao J; Department of Pathology and Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China. Electronic address: jmzhao302@163.com.
J Hepatol ; 73(4): 807-816, 2020 10.
Article in English | MEDLINE | ID: covidwho-345685
ABSTRACT
Background &

Aims:

Liver enzyme abnormalities are common in patients with coronavirus disease 2019 (COVID-19). Whether or not severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can lead to liver damage per se remains unknown. Herein, we reported the clinical characteristics and liver pathological manifestations of COVID-19 patients with liver enzyme abnormalities.

Methods:

We analyzed 156 patients diagnosed with COVID-19 from 2 designated centers in China and compared clinical features between patients with or without elevated aminotransferases. Postmortem liver biopsies were obtained from 2 cases who had elevated aminotransferases. We investigated the patterns of liver impairment by electron microscopy, immunohistochemistry, TUNEL assay and pathological studies.

Results:

Sixty-four out of 156 (41.0%) patients with COVID-19 had elevated aminotransferases. The median levels of alanine aminotransferase were 50 U/L vs. 19 U/L, respectively, aspartate aminotransferase were 45.5 U/L vs. 24 U/L, respectively in abnormal and normal aminotransferase groups. Liver enzyme abnormalities were associated with disease severity, as well as a series of laboratory tests including higher alveolar-arterial oxygen partial pressure difference, higher gamma-glutamyltransferase, lower albumin, decreased CD4+ T cells and B lymphocytes. Ultrastructural examination identified typical coronavirus particles, characterized by spike structures, in the cytoplasm of hepatocytes in 2 COVID-19 cases. SARS-CoV-2-infected hepatocytes displayed conspicuous mitochondrial swelling, endoplasmic reticulum dilatation and glycogen granule decrease. Histologically, massive hepatic apoptosis and some binuclear hepatocytes were observed. Taken together, both ultrastructural and histological evidence indicated a typical lesion of viral infection. Immunohistochemical results showed scarce CD4+ and CD8+ lymphocytes. No obvious eosinophil infiltration, cholestasis, fibrin deposition, granuloma, massive central necrosis, or interface hepatitis were observed.

Conclusions:

SARS-CoV-2 infection in the liver directly contributes to hepatic impairment in patients with COVID-19. Hence, a surveillance of viral clearance in liver and long-term outcome of COVID-19 is required. Lay

summary:

Liver enzyme abnormalities are common in patients with coronavirus disease 2019 (COVID-19). We reported the clinical characteristics and liver pathological manifestations of COVID-19 patients with elevated liver enzymes. Our findings suggested that SARS-CoV-2 infection of the liver is a crucial factor contributing to hepatic impairment in patients with COVID-19.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Aspartate Aminotransferases / Coronavirus Infections / Alanine Transaminase / Pandemics / Liver / Liver Diseases Type of study: Diagnostic study / Experimental Studies / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Humans / Male / Middle aged Language: English Journal: J Hepatol Journal subject: Gastroenterology Year: 2020 Document Type: Article Affiliation country: J.jhep.2020.05.002

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Aspartate Aminotransferases / Coronavirus Infections / Alanine Transaminase / Pandemics / Liver / Liver Diseases Type of study: Diagnostic study / Experimental Studies / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Humans / Male / Middle aged Language: English Journal: J Hepatol Journal subject: Gastroenterology Year: 2020 Document Type: Article Affiliation country: J.jhep.2020.05.002