ArticleHepatology research : the official journal of the Japan Society of Hepatology2021
Pathological characteristics of liver sinusoidal thrombosis in COVID-19 patients: A series of 43 cases.
Article in Hepatology research : the official journal of the Japan Society of Hepatology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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17 citing papers in PubMed, 29 citations in OpenAlex.
- COVID-19 Infection, Drugs, and Liver Injury.Journal of clinical medicine · 2025Review
- Histopathological impact of SARS-CoV-2 on the liver: Cellular damage and long-term complications.World journal of gastroenterology · 2024Review
- Pylephlebitis-induced acute liver failure: A case report and review of literature.World journal of hepatology · 2024Article
- Hepatobiliary long-term consequences of COVID-19: dramatically increased rate of secondary sclerosing cholangitis in critically ill COVID-19 patients.Hepatology international · 2023Observational
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- Microvascular Thrombosis and Liver Fibrosis Progression: Mechanisms and Clinical Applications.Cells · 2023Review
- Alterations in platelet proteome signature and impaired platelet integrin αJournal of thrombosis and haemostasis : JTH · 2023Article
- Extracardiac Prothrombotic Effects of COVID-19.Heart failure clinics · 2023Review
- Histology and cytokine levels in hepatic injury accompanying a case of non-severe COVID-19.Clinical journal of gastroenterology · 2023Article
- Outcomes in Patients with Liver Dysfunction Post SARS-CoV-2 Infection: What Should We Measure?Hepatic medicine : evidence and research · 2023Review
- Diabetes Mellitus May Exacerbate Liver Injury in Patients with COVID-19: A Single-Center, Observational, Retrospective Study.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2022Article
- Extracardiac Prothrombotic Effects of COVID-19.Cardiology clinics · 2022Review
- Vascular endotheliitis associated with infections: Its pathogenetic role and therapeutic implication.Biochemical pharmacology · 2022Review
- Covid-19 and Liver Injury: Role of Inflammatory Endotheliopathy, Platelet Dysfunction, and Thrombosis.Hepatology communications · 2022Review
- The Role of Von Willebrand Factor in the Pathogenesis of Pulmonary Vascular Thrombosis in COVID-19.Viruses · 2022Article
- COVID-19 and the Vasculature: Current Aspects and Long-Term Consequences.Frontiers in cell and developmental biology · 2022Review
- Pathological characteristics of liver sinusoidal thrombosis in COVID-19 patients: A series of 43 cases.Hepatology research : the official journal of the Japan Society of Hepatology · 2021Article
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16 authors at 4 institutions in 3 countries.
Funding
Abstract
aimCoronavirus disease (COVID-19) is characterized by pneumonia with secondary damage to multiple organs including the liver. Liver injury (elevated alanine aminotransferase [ALT] and aspartate aminotransferase [AST]) often correlates with disease severity in COVID-19 patients. The aim of this study is to identify pathological microthrombi in COVID-19 patient livers by correlating their morphology with liver injury, and examine hyperfibrinogenemia and von Willebrand factor (vWF) as mechanisms of their formation.
methodsForty-three post-mortem liver biopsy samples from COVID-19 patients were obtained from Papa Giovanni XXIII Hospital in Bergamo, Italy. Three morphological features of microthrombosis (sinusoidal erythrocyte aggregation [SEA], platelet microthrombi [PMT], and fibrous thrombi) were evaluated.
resultsWe found liver sinusoidal microthrombosis in 23 COVID-19 patients (53%) was associated with a higher serum ALT and AST level compared to those without (ALT: 10-fold, p = 0.04; AST: 11-fold, p = 0.08). Of 43 livers, PMT and SEA were observed in 14 (33%) and 19 (44%) cases, respectively. Fibrous thrombi were not observed. Platelet microthrombi were associated with increased ALT (p < 0.01), whereas SEA was not (p = 0.73). In COVID-19 livers, strong vWF staining in liver sinusoidal endothelial cells was associated with significantly increased platelet adhesion (1.7-fold, p = 0.0016), compared to those with weak sinusoidal vWF (2-fold, p < 0.0001). Sinusoidal erythrocyte aggregation in 19 (83%) liver samples was mainly seen in zone 2. Livers with SEA had significantly higher fibrinogen (1.6-fold, p = 0.031) compared to those without SEA in COVID-19 patients.
conclusionsLiver PMT is a pathologically important thrombosis associated with liver injury in COVID-19, while SEA is a unique morphological feature of COVID-19 patient livers. Sinusoidal vWF and hyperfibrinogenemia could contribute to PMT and SEA formation.
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