ArticleHepatology communications2022
Correlation Between Clinical and Pathological Findings of Liver Injury in 27 Patients With Lethal COVID-19 Infections in Brazil.
Article in Hepatology communications, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 17 papers.
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Who cites it
17 citing papers in PubMed, 22 citations in OpenAlex.
- Profiles of PCSK9, SREBP-2, and histopathology in COVID-19 and non-COVID-19 critical illness.BMC infectious diseases · 2025Article
- COVID-19-Related Cholangiopathy: Histological Findings.Diagnostics (Basel, Switzerland) · 2024Article
- Histopathological impact of SARS-CoV-2 on the liver: Cellular damage and long-term complications.World journal of gastroenterology · 2024Review
- Diabetes Mellitus, Energy Metabolism, and COVID-19.Endocrine reviews · 2024Review
- Emerging role of complement in COVID-19 and other respiratory virus diseases.Cellular and molecular life sciences : CMLS · 2024Review
- Molecular mechanisms underlying SARS-CoV-2 hepatotropism and liver damage.World journal of hepatology · 2024Article
- Hepatic endotheliitis in Golden Syrian hamsters (Mesocricetus auratus) experimentally infected with SARS-CoV-2.Revista do Instituto de Medicina Tropical de Sao Paulo · 2024Article
- The Liver Can Deliver: Utility of Hepatic Function Tests as Predictors of Outcome in COVID-19, Influenza and RSV Infections.Journal of clinical medicine · 2023Article
- Non-alcoholic fatty liver disease and COVID-19: Harmless companions or disease intensifier?World journal of gastroenterology · 2023Review
- Clinical and Histopathological Discoveries in Patients with Hepatic Injury and Cholangiopathy Who Have Died of COVID-19: Insights and Opportunities for Intervention.Hepatic medicine : evidence and research · 2023Review
- Liver injury in COVID-19: A minireview.World journal of gastroenterology · 2022Review
- Article
- Complement-mediated microvascular injury and thrombosis in the pathogenesis of severe COVID-19: A review.World journal of experimental medicine · 2022Review
- Tissue-specific pathway activities: A retrospective analysis in COVID-19 patients.Frontiers in immunology · 2022Article
- The pathological mechanism of the COVID-19 convalescence and its treatment with traditional Chinese medicine.Frontiers in pharmacology · 2022Review
- The des-ArgFrontiers in physiology · 2022Article
- Pregnancy and COVID-19 - liver damage.Medicine and pharmacy reports · 2021Article
Corrections and comments
- Erratum issued
Authors and funding
18 authors at 4 institutions in 2 countries.
Funding
Abstract
Liver test abnormalities are frequently observed in patients with coronavirus disease 2019 (COVID-19) and are associated with worse prognosis. However, information is limited about pathological changes in the liver in this infection, so the mechanism of liver injury is unclear. Here we describe liver histopathology and clinical correlates of 27 patients who died of COVID-19 in Manaus, Brazil. There was a high prevalence of liver injury (elevated alanine aminotransferase and aspartate aminotransferase in 44% and 48% of patients, respectively) in these patients. Histological analysis showed sinusoidal congestion and ischemic necrosis in more than 85% of the cases, but these appeared to be secondary to systemic rather than intrahepatic thrombotic events, as only 14% and 22% of samples were positive for CD61 (marker of platelet activation) and C4d (activated complement factor), respectively. Furthermore, the extent of these vascular findings did not correlate with the extent of transaminase elevations. Steatosis was present in 63% of patients, and portal inflammation was present in 52%. In most cases, hepatocytes expressed angiotensin-converting enzyme 2 (ACE2), which is responsible for binding and entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), even though this ectoenzyme was minimally expressed on hepatocytes in normal controls. However, SARS-CoV-2 staining was not observed. Most hepatocytes also expressed inositol 1,4,5-triphosphate receptor 3 (ITPR3), a calcium channel that becomes expressed in acute liver injury. Conclusion: The hepatocellular injury that commonly occurs in patients with severe COVID-19 is not due to the vascular events that contribute to pulmonary or cardiac damage. However, new expression of ACE2 and ITPR3 with concomitant inflammation and steatosis suggests that liver injury may result from inflammation, metabolic abnormalities, and perhaps direct viral injury.
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