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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
High prevalence of hepatic steatosis and vascular thrombosis in COVID-19: A systematic review and meta-analysis of autopsy data
Luis Antonio Díaz, Francisco Idalsoaga, Macarena Cannistra, Roberto Candia, Daniel Cabrera, Francisco Barrera, Alejandro Soza, Rondell Graham, Arnoldo Riquelme, Marco Arrese, Michael D Leise, Juan Pablo Arab
Luis Antonio Díaz, Roberto Candia, Francisco Barrera, Alejandro Soza, Arnoldo Riquelme, Juan Pablo Arab, Department of Gastroenterology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago 8320000, Chile
Francisco Idalsoaga, Department of Internal Medicine, Pontificia Universidad Católica de Chile, Santiago 8320000, Chile
Macarena Cannistra, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8320000, Chile
Daniel Cabrera, Facultad de Ciencias Médicas, Universidad Bernardo O'Higgins, Santiago 8320000, Chile
Rondell Graham, Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Minnesota, MN 55902, United States
Marco Arrese, Department of Gastroenterology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago 8320000, Chile
Michael D Leise, Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Minnesota, MN 55905, United States
Author contributions: Díaz LA and Arab JP are responsible for the overall content of the project and the manuscript submitted as guarantors of the project; Díaz LA, Idalsoaga F and Cannistra M had full access to all the data in the study; Díaz LA, Idalsoaga F, Candia R and Arab JP take responsibility for the integrity of the data and the accuracy of the data analysis; Díaz LA and Arab JP take the final decision to submit for publication; Díaz LA, Idalsoaga F, Cannistra M, Candia R, Arab JP, Graham R, Leise MD and Riquelme A contributed analysis or interpretation of data; Díaz LA, Arab JP, Leise MD, Graham R and Riquelme A contributed drafting of the manuscript; Díaz LA, Idalsoaga F, Cannistra M, Candia R, Cabrera D, Barrera F, Soza A, Graham R, Riquelme A, Arrese M, Leise MD and Arab JP contributed critical revision of the manuscript for relevant intellectual content; Díaz LA and Candia R contributed statistical analysis.
Supported by Chilean Government Through the Fondo Nacional de Desarrollo Científico y Tecnológico, No. 1200227, No. 1191183 and No. 1191145; Comisión Nacional de Investigación Científica y Tecnológica (CONICYT, CARE Chile UC), No. AFB170005; and European Union’s Horizon 2020 Research, No. 825510.
Conflict-of-interest statement: The authors have nothing to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Juan Pablo Arab, MD, Assistant Professor, Department of Gastroenterology, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Departamento de Gastroenterología, Santiago 8320000, Chile. jparab@med.puc.cl
Received: October 21, 2020
Peer-review started: October 21, 2020
First decision: November 13, 2020
Revised: November 26, 2020
Accepted: December 6, 2020
Article in press: December 6, 2020
Published online: December 28, 2020
ARTICLE HIGHLIGHTS
Research background
The liver is frequently involved during severe acute respiratory syndrome coronavirus 2 infection and coronavirus disease 2019 (COVID-19). However, there is no consensus about the main histopathological findings in COVID-19.
Research motivation
Identifying the main histopathological findings could help understand the mechanism of liver injury frequently observed in COVID-19 patients.
Research objectives
The characterization of the liver histopathological findings will impact the interpretation of liver chemistries and liver biopsies in COVID-19 patients.
Research methods
We conducted a systematic review and meta-analysis, including liver biopsies and autopsies of COVID-19 patients. Proportions were estimated using random-effects models.
Research results
We included 18 studies. The major histological findings are hepatic steatosis (55.1%), congestion of hepatic sinuses (34.7%), vascular thrombosis (29.4%), fibrosis (20.5%), Kupffer cell hyperplasia (13.5%), portal inflammation (13.2%), and lobular inflammation (11.6%). Other abnormalities can be identified, such as venous outflow obstruction, phlebosclerosis of the portal vein, herniated portal vein, periportal abnormal vessels, hemophagocytosis, and necrosis.
Research conclusions
Steatosis, vascular thrombosis, fibrosis, and inflammatory abnormalities are the most frequent liver histopathological findings in COVID-19 patients.
Research perspectives
The multiple liver histopathological findings observed in COVID-19 demonstrate the susceptibility to liver injury in risk populations, the inflammatory response, and thrombosis associated with this infection.
