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Saviano A, Wrensch F, Ghany MG, Baumert TF. Liver Disease and Coronavirus Disease 2019: From Pathogenesis to Clinical Care. Hepatology 2021; 74:1088-1100. [PMID: 33332624 PMCID: PMC8209116 DOI: 10.1002/hep.31684] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/01/2020] [Accepted: 12/03/2020] [Indexed: 01/08/2023]
Abstract
Infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus that emerged in late 2019, is posing an unprecedented challenge to global health. Coronavirus disease 2019 (COVID-19), the clinical disease caused by SARS-CoV-2, has a variable presentation ranging from asymptomatic infection to life-threatening acute respiratory distress syndrome and multiorgan failure. Liver involvement is common during COVID-19 and exhibits a spectrum of clinical manifestations from asymptomatic elevations of liver function tests to hepatic decompensation. The presence of abnormal liver tests has been associated with a more severe presentation of COVID-19 disease and overall mortality. Although SARS-CoV-2 RNA has been detected in the liver of patients with COVID-19, it remains unclear whether SARS-CoV-2 productively infects and replicates in liver cells and has a direct liver-pathogenic effect. The cause of liver injury in COVID-19 can be attributed to multiple factors, including virus-induced systemic inflammation, hypoxia, hepatic congestion, and drug-induced liver disease. Among patients with cirrhosis, COVID-19 has been associated with hepatic decompensation and liver-related mortality. Additionally, COVID-19's impact on health care resources can adversely affect delivery of care and outcomes of patients with chronic liver disease. Understanding the underlying mechanisms of liver injury during COVID-19 will be important in the management of patients with COVID-19, especially those with advanced liver disease. This review summarizes our current knowledge of SARS-CoV-2 virus-host interactions in the liver as well the clinical impact of liver disease in COVID-19.
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Affiliation(s)
- Antonio Saviano
- Inserm, U1110Institut de Recherche sur les Maladies Virales et HépatiquesUniversité de StrasbourgStrasbourgFrance
- Institut Hospitalo‐UniversitairePôle Hépato‐digestifNouvel Hôpital CivilStrasbourgFrance
| | - Florian Wrensch
- Inserm, U1110Institut de Recherche sur les Maladies Virales et HépatiquesUniversité de StrasbourgStrasbourgFrance
| | - Marc G. Ghany
- Liver Diseases BranchNational Institute of DiabetesDigestive and Kidney DiseasesNational Institutes of HealthBethesdaMD
| | - Thomas F. Baumert
- Inserm, U1110Institut de Recherche sur les Maladies Virales et HépatiquesUniversité de StrasbourgStrasbourgFrance
- Institut Hospitalo‐UniversitairePôle Hépato‐digestifNouvel Hôpital CivilStrasbourgFrance
- Institut Universitaire de FranceParisFrance
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152
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Sweed D, Abdelsameea E, Khalifa EA, Abdallah H, Moaz H, Moaz I, Abdelsattar S, Abdel-Rahman N, Mosbeh A, Elmahdy HA, Sweed E. SARS-CoV-2-associated gastrointestinal and liver diseases: what is known and what is needed to explore. EGYPTIAN LIVER JOURNAL 2021; 11:64. [PMID: 34777871 PMCID: PMC8325538 DOI: 10.1186/s43066-021-00123-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The pandemic of COVID19 which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first described in China as an unexplained pneumonia transmitted by respiratory droplets. Gastrointestinal (GI) and liver injury associated with SARS-CoV-2 infection were reported as an early or sole disease manifestation, mainly outside China. The exact mechanism and incidence of GI and liver involvement are not well elucidated. MAIN BODY We conducted a PubMed search for all articles written in the English language about SARS-CoV-2 affecting the GI and liver. Following data extraction, 590 articles were selected. In addition to respiratory droplets, SARS-CoV-2 may reach the GI system through the fecal-oral route, saliva, and swallowing of nasopharyngeal fluids, while breastmilk and blood transmission were not implicated. Moreover, GI infection may act as a septic focus for viral persistence and transmission to the liver, appendix, and brain. In addition to the direct viral cytopathic effect, the mechanism of injury is multifactorial and is related to genetic and demographic variations. The most frequently reported GI symptoms are diarrhea, nausea, vomiting, abdominal pain, and bleeding. However, liver infection is generally discovered during laboratory testing or a post-mortem. Radiological imaging is the gold standard in diagnosing COVID-19 patients and contributes to understanding the mechanism of extra-thoracic involvement. Medications should be prescribed with caution, especially in chronic GI and liver patients. CONCLUSION GI manifestations are common in COVID-19 patients. Special care should be paid for high-risk patients, older males, and those with background liver disease.
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Affiliation(s)
- Dina Sweed
- Pathology Department, National Liver Institute, Menofia University, Shibin El Kom, 32511 Egypt
| | - Eman Abdelsameea
- Hepatology and Gastroenterology Department, National Liver Institute, Menofia University, Shibin El Kom, Egypt
| | - Esraa A. Khalifa
- Radiology Department, Faculty of Medicine, Menofia University, Shibin El Kom, Egypt
| | - Heba Abdallah
- Clinical Pathology Department, National Liver Institute, Menofia University, Shibin El Kom, Egypt
| | - Heba Moaz
- Microbiology Department, Faculty of Medicine, Menofia University, Shibin El Kom, Egypt
| | - Inas Moaz
- Epidemiology and Preventive Medicine Department, Menofia University, Shibin El Kom, Egypt
| | - Shimaa Abdelsattar
- Clinical Biochemistry, and Molecular Diagnostics Department, National Liver Institute, Menofia University, Shibin El Kom, Egypt
| | | | - Asmaa Mosbeh
- Pathology Department, National Liver Institute, Menofia University, Shibin El Kom, 32511 Egypt
| | - Hussein A. Elmahdy
- Biochemistry Department, Faculty of Science, Cairo University, Giza, Egypt
| | - Eman Sweed
- Clinical Pharmacology Department, Faculty of Medicine, Menofia University, Shibin El Kom, Egypt
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153
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Ray A, Jain D, Goel A, Agarwal S, Swaroop S, Das P, Arava SK, Mridha AR, Nambirajan A, Singh G, Arulselvi S, Mathur P, Kumar S, Sahni S, Nehra J, Nazneen, Bm M, Rastogi N, Mahato S, Gupta C, Bharadhan S, Dhital G, Goel P, Pandey P, Kn S, Chaudhary S, Keri VC, Chauhan VS, Mahishi N, Shahi A, R R, Gupta BK, Aggarwal R, Soni KD, Nischal N, Soneja M, Lalwani S, Sarkar C, Guleria R, Wig N, Trikha A. Clinico-pathological features in fatal COVID-19 infection: a preliminary experience of a tertiary care center in North India using postmortem minimally invasive tissue sampling. Expert Rev Respir Med 2021; 15:1367-1375. [PMID: 34227439 DOI: 10.1080/17476348.2021.1951708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To study the histopathology of patients dying of COVID-19 using post-mortem minimally invasive sampling techniques. METHODS This was a single-center observational study conducted at JPNATC, AIIMS. Thirty-seven patients who died of COVID-19 were enrolled. Post-mortem percutaneous biopsies were taken from lung, heart, liver, kidney and stained with hematoxylin and eosin. Immunohistochemistry was performed using CD61 and CD163. SARS-CoV-2 virus was detected using IHC with primary antibodies. RESULTS The mean age was 48.7 years and 59.5% were males. Lung histopathology showed diffuse alveolar damage in 78% patients. Associated bronchopneumonia was seen in 37.5% and scattered microthrombi in 21% patients. Immunopositivity for SARS-CoV-2 was observed in Type II pneumocytes. Acute tubular injury with epithelial vacuolization was seen in 46% of renal biopsies. Seventy-one percent of liver biopsies showed Kupffer cell hyperplasia and 27.5% showed submassive hepatic necrosis. CONCLUSIONS Predominant finding was diffuse alveolar damage with demonstration of SARS-CoV-2 protein in the acute phase. Microvascular thrombi were rarely identified in any organ. Substantial hepatocyte necrosis, Kupffer cell hypertrophy, microvesicular, and macrovesicular steatosis unrelated to microvascular thrombi suggested that liver might be a primary target of COVID-19.
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Affiliation(s)
- Animesh Ray
- Department of Medicine, AIIMS, New Delhi, India
| | - Deepali Jain
- Department of Pathology, AIIMS, New Delhi, India
| | - Ayush Goel
- Department of Medicine, AIIMS, New Delhi, India
| | | | | | | | | | | | | | | | - S Arulselvi
- Department of Laboratory Medicine, Jpnatc, Aiims, New Delhi, India
| | - Purva Mathur
- Department of Laboratory Medicine, Jpnatc, Aiims, New Delhi, India
| | | | | | | | - Nazneen
- Department of Medicine, AIIMS, New Delhi, India
| | - Mouna Bm
- Department of Medicine, AIIMS, New Delhi, India
| | | | | | | | - S Bharadhan
- Department of Medicine, AIIMS, New Delhi, India
| | | | - Pawan Goel
- Department of Medicine, AIIMS, New Delhi, India
| | | | - Santosh Kn
- Department of Medicine, AIIMS, New Delhi, India
| | | | | | | | | | - Anand Shahi
- Department of Medicine, AIIMS, New Delhi, India
| | - Ragu R
- Department of Medicine, AIIMS, New Delhi, India
| | | | | | | | | | | | - Sanjeev Lalwani
- Division of Forensic Pathology and Molecular Laboratory, JPNATC, AIIMS, New Delhi, India
| | | | - Randeep Guleria
- Department of Pulmonary Medicine, Sleep and critical care disorders, Director, AIIMS, New Delhi, India
| | - Naveet Wig
- Department of Medicine, AIIMS, New Delhi, India
| | - Anjan Trikha
- Department of Anaesthesiology, Critical Care and Pain Medicine, JPNATC, AIIMS, New Delhi, India
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154
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Cienfuegos JA, Valentí V, Rotellar F. Hepatic injury and COVID-19: pathogenic mechanisms or epiphenomena? REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 113:554-555. [PMID: 33569967 DOI: 10.17235/reed.2021.7851/2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Ampuero J et al. analyzed the relationship between liver injury and clinical progression of the disease in a meta-analysis of over 5,000 COVID-19 patients. The authors reported an association between increased aspartate aminotransferase (AST), alanine aminotransferase (ALT) and bilirubin levels with mortality, admission to Intensive Care and the development of complications, respectively.
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155
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Gracia-Ramos AE, Jaquez-Quintana JO, Contreras-Omaña R, Auron M. Liver dysfunction and SARS-CoV-2 infection. World J Gastroenterol 2021; 27:3951-3970. [PMID: 34326607 PMCID: PMC8311530 DOI: 10.3748/wjg.v27.i26.3951] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/09/2021] [Accepted: 06/16/2021] [Indexed: 02/06/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 infection is the cause of coronavirus disease 2019 (COVID-19), which predominantly affects the respiratory system; it also causes systemic and multi-organic disease. Liver damage is among the main extrapulmonary manifestations. COVID-19-associated liver injury is defined as any liver damage occurring during the disease course and treatment of COVID-19 in patients with or without pre-existing liver disease, and occurs in approximately one in five patients. Abnormal liver test results have been associated with a more severe course of COVID-19 and other complications, including death. Mechanisms linking COVID-19 to liver injury are diverse. Particular consideration should be made for patients with pre-existing liver disease, such as metabolic dysfunction-associated fatty liver disease, chronic liver disease due to viral or autoimmune disease, liver transplant carriers, or cirrhosis, given the risk for more severe outcomes. This manuscript summarizes the current lines of evidence on COVID-19-associated liver injury regarding pathophysiology, clinical significance, and management in both patients with or without pre-existing liver disease, to facilitate clinicians' access to updated information and patient care. Finally, we mention the ideas and recommendations to be considered for future research.
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Affiliation(s)
- Abraham Edgar Gracia-Ramos
- Department of Internal Medicine, General Hospital, National Medical Center "La Raza", Instituto Mexicano del Seguro Social, Mexico City 02990, Mexico
| | - Joel Omar Jaquez-Quintana
- Gastroenterology Service and Department of Internal Medicine, Faculty of Medicine, University Hospital "Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico
| | - Raúl Contreras-Omaña
- Centro de Estudio e Investigación en Enfermedades Hepáticas y Toxicológicas (CEIHET), Pachuca 42184, Mexico
| | - Moises Auron
- Departments of Hospital Medicine and Pediatric Hospital Medicine, Cleveland Clinic, Cleveland, OH 44195, United States
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Bhandarwar AH, Bakhshi GD, Arora E, Dhimole N, Bijwe SR, Agale SV, Kinake MS, Domkundwar S, Thube Y. Assessing viability of a minimally invasive autopsy technique in ascertaining the probable cause of death in patients who were SARS CoV19 positive at the time of their demise. SURGICAL AND EXPERIMENTAL PATHOLOGY 2021. [PMCID: PMC8276030 DOI: 10.1186/s42047-021-00094-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background SARS CoV-19 was declared as a pandemic by the World Health Organization (WHO), raising up challenges on various levels ranging from therapeutics to diagnostics. The conventional autopsy technique may pose a health hazard to health care workers. A minimally invasive autopsy technique can diminish this hazard. Materials and methods Between August and November 2020, 51 patients who were suffering from Covid-19 at the time of their demise were included. A novel minimally invasive ultrasound-guided technique for procuring tissue samples of major organs was employed which were thereafter subject to histopathological examination. A detailed review of the course in hospital was noted. An analysis was performed to correlate the cause of death ascertained from our minimally invasive technique with the cause of death ascertained clinically. Results There was adequate tissue sampling in 45 cases, where the minimally invasive autopsy technique confirmed the cause of death in all 45 cases (100%) and made it more specific in 5 cases (11.11%). Conclusion Minimally Invasive Autopsy is an easily reproducible technique which has the potential to strengthen the probable the cause of death with reasonable certainty while ensuring safety and ethics.
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157
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Cholangiopathy After Severe COVID-19: Clinical Features and Prognostic Implications. Am J Gastroenterol 2021; 116:1414-1425. [PMID: 33993134 DOI: 10.14309/ajg.0000000000001264] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/12/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 virus, is a predominantly respiratory tract infection with the capacity to affect multiple organ systems. Abnormal liver tests, mainly transaminase elevations, have been reported in hospitalized patients. We describe a syndrome of cholangiopathy in patients recovering from severe COVID-19 characterized by marked elevation in serum alkaline phosphatase (ALP) accompanied by evidence of bile duct injury on imaging. METHODS We conducted a retrospective study of COVID-19 patients admitted to our institution from March 1, 2020, to August 15, 2020, on whom the hepatology service was consulted for abnormal liver tests. Bile duct injury was identified by abnormal liver tests with serum ALP > 3x upper limit of normal and abnormal findings on magnetic resonance cholangiopacreatography. Clinical, laboratory, radiological, and histological findings were recorded in a Research Electronic Data Capture database. RESULTS Twelve patients were identified, 11 men and 1 woman, with a mean age of 58 years. Mean time from COVID-19 diagnosis to diagnosis of cholangiopathy was 118 days. Peak median serum alanine aminotransferase was 661 U/L and peak median serum ALP was 1855 U/L. Marked elevations of erythrocyte sedimentation rate, C-reactive protein, and D-dimers were common. Magnetic resonance cholangiopacreatography findings included beading of intrahepatic ducts (11/12, 92%), bile duct wall thickening with enhancement (7/12, 58%), and peribiliary diffusion high signal (10/12, 83%). Liver biopsy in 4 patients showed acute and/or chronic large duct obstruction without clear bile duct loss. Progressive biliary tract damage has been demonstrated radiographically. Five patients were referred for consideration of liver transplantation after experiencing persistent jaundice, hepatic insufficiency, and/or recurrent bacterial cholangitis. One patient underwent successful living donor liver transplantation. DISCUSSION Cholangiopathy is a late complication of severe COVID-19 with the potential for progressive biliary injury and liver failure. Further studies are required to understand pathogenesis, natural history, and therapeutic interventions.
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158
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D'Amico FE, Glavas D, Noaro G, Bassi D, Boetto R, Gringeri E, De Luca M, Cillo U. Case Report: Liver Cysts and SARS-CoV-2: No Evidence of Virus in Cystic Fluid. Front Surg 2021; 8:677889. [PMID: 34222319 PMCID: PMC8249569 DOI: 10.3389/fsurg.2021.677889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/11/2021] [Indexed: 01/08/2023] Open
Abstract
Background: In December 2019, an outbreak of pneumonia, caused by a new type of coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It quickly spread worldwide, resulting in a pandemic. The clinical manifestations of SARS-CoV-2 range from mild non-specific symptoms to severe pneumonia with organ function damage. In addition, up to 60% of patients have liver impairment or dysfunction, confirmed by several studies by the presence of SARS-CoV-2 in the liver tissue. Methods: We report two cases of symptomatic liver cyst requiring fenestration after recent SARS-CoV-2 infection. Both patients had hospital admission due to documented SARS-CoV-2 infection. Recently, after the infection, they developed symptoms caused by an enlarged hepatic cyst: one had abdominal pain, and the other had jaundice. They underwent surgery after two negative swab tests for SARS-CoV-2. Results: Cystic fluid was sent for microbiological test, and real-time fluorescence polymerase chain reaction COVID-19 nucleic-acid assay of the cyst fluid was found to be negative in both cases. Discussion: Although there are no current data that can document a viral contamination of cystic fluid, there are data that document a hepatotropism of COVID-19 virus. Herein we report that after viral clearance at pharyngeal and nasal swab, there is no evidence of viral load in such potential viral reservoir.
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Affiliation(s)
- Francesco Enrico D'Amico
- Department of Surgical, Oncological and Gastroenterologica Sciences (DiSCOG), University of Padova, Padua, Italy.,Hepatobiliary and Liver Transplant Surgery, Padova Teaching Hospital, Padua, Italy
| | - Dajana Glavas
- Department of Surgical, Oncological and Gastroenterologica Sciences (DiSCOG), University of Padova, Padua, Italy.,Hepatobiliary and Liver Transplant Surgery, Padova Teaching Hospital, Padua, Italy
| | - Giulia Noaro
- Department of Surgery, Montebelluna Hospital ULSS2, Montebelluna, Italy
| | - Domenico Bassi
- Hepatobiliary and Liver Transplant Surgery, Padova Teaching Hospital, Padua, Italy
| | - Riccardo Boetto
- Hepatobiliary and Liver Transplant Surgery, Padova Teaching Hospital, Padua, Italy
| | - Enrico Gringeri
- Department of Surgical, Oncological and Gastroenterologica Sciences (DiSCOG), University of Padova, Padua, Italy.,Hepatobiliary and Liver Transplant Surgery, Padova Teaching Hospital, Padua, Italy
| | - Maurizio De Luca
- Department of Surgery, Montebelluna Hospital ULSS2, Montebelluna, Italy
| | - Umberto Cillo
- Department of Surgical, Oncological and Gastroenterologica Sciences (DiSCOG), University of Padova, Padua, Italy.,Hepatobiliary and Liver Transplant Surgery, Padova Teaching Hospital, Padua, Italy
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159
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Cai Y, Ye LP, Song YQ, Mao XL, Wang L, Jiang YZ, Que WT, Li SW. Liver injury in COVID-19: Detection, pathogenesis, and treatment. World J Gastroenterol 2021; 27:3022-3036. [PMID: 34168405 PMCID: PMC8192279 DOI: 10.3748/wjg.v27.i22.3022] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/24/2021] [Accepted: 04/22/2021] [Indexed: 02/06/2023] Open
Abstract
In the early December 2019, a novel coronavirus named severe acute respiratory syndrome coronavirus 2 was first reported in Wuhan, China, followed by an outbreak that spread around the world. Numerous studies have shown that liver injury is common in patients with coronavirus disease 2019 (COVID-19), and may aggravate the severity of the disease. However, the exact cause and specific mechanism of COVID-associated liver injury needs to be elucidated further. In this review, we present an analysis of the clinical features, potential mechanisms, and treatment strategies for liver injury associated with COVID-19. We hope that this review would benefit clinicians in devising better strategies for management of such patients.
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Affiliation(s)
- Yue Cai
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Li-Ping Ye
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
- School of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
| | - Ya-Qi Song
- School of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
| | - Xin-Li Mao
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Li Wang
- College of Basic Medicine, Inner Mongolia Medical University, Hohhot 010000, Inner Mongolia Autonomous Region, China
| | - Yan-Zhi Jiang
- Department of Gastroenterology and Hepatology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200000, China
| | - Wei-Tao Que
- Department of Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200000, China
| | - Shao-Wei Li
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
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160
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Laudanski K, Jihane H, Antalosky B, Ghani D, Phan U, Hernandez R, Okeke T, Wu J, Rader D, Susztak K. Unbiased Analysis of Temporal Changes in Immune Serum Markers in Acute COVID-19 Infection With Emphasis on Organ Failure, Anti-Viral Treatment, and Demographic Characteristics. Front Immunol 2021; 12:650465. [PMID: 34177897 PMCID: PMC8226183 DOI: 10.3389/fimmu.2021.650465] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/10/2021] [Indexed: 12/29/2022] Open
Abstract
Identification of novel immune biomarkers to gauge the underlying pathology and severity of COVID-19 has been difficult due to the lack of longitudinal studies. Here, we analyzed serum collected upon COVID-19 admission (t1), 48 hours (t2), and seven days later (t3) using Olink proteomics and correlated to clinical, demographics, and therapeutic data. Older age positively correlated with decorin, pleiotrophin, and TNFRS21 but inversely correlated with chemokine (both C-C and C-X-C type) ligands, monocyte attractant proteins (MCP) and TNFRS14. The burden of pre-existing conditions was positively correlated with MCP-4, CAIX, TWEAK, TNFRS12A, and PD-L2 levels. Individuals with COVID-19 demonstrated increased expression of several chemokines, most notably from the C-C and C-X-C family, as well as MCP-1 and MCP-3 early in the course of the disease. Similarly, deceased individuals had elevated MCP-1 and MCP-3 as well as Gal-9 serum levels. LAMP3, GZMB, and LAG3 at admission correlated with mortality. Only CX3CL13 and MCP-4 correlated positively with APACHE score and length of stay, while decorin, MUC-16 and TNFRSF21 with being admitted to the ICU. We also identified several organ-failure-specific immunological markers, including those for respiratory (IL-18, IL-15, Gal-9) or kidney failure (CD28, VEGF). Treatment with hydroxychloroquine, remdesivir, convalescent plasma, and steroids had a very limited effect on the serum variation of biomarkers. Our study identified several potential targets related to COVID-19 heterogeneity (MCP-1, MCP-3, MCP-4, TNFR superfamily members, and programmed death-ligand), suggesting a potential role of these molecules in the pathology of COVID-19.
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Affiliation(s)
- Krzysztof Laudanski
- Department of Anesthesiology and Critical Care, The University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute for Healthcare Economics, The University of Pennsylvania, Philadelphia, PA, United States
- Department of Neurology, The University of Pennsylvania, Philadelphia, PA, United States
| | - Hajj Jihane
- School of Nursing, Widener University, Philadelphia, PA, United States
| | - Brook Antalosky
- College of Arts and Sciences, Drexel University, Philadelphia, PA, United States
| | - Danyal Ghani
- College of Arts and Sciences, Drexel University, Philadelphia, PA, United States
| | - Uyen Phan
- College of Arts and Sciences, Drexel University, Philadelphia, PA, United States
| | - Ruth Hernandez
- College of Arts and Sciences, Drexel University, Philadelphia, PA, United States
| | - Tony Okeke
- School of Biomedical Engineering, Drexel University, Philadelphia, PA, United States
| | - Junnan Wu
- Department of Genetics, The University of Pennsylvania, Philadelphia, PA, United States
- Department of Nephrology, The University of Pennsylvania, Philadelphia, PA, United States
| | - Daniel Rader
- Department of Genetics, The University of Pennsylvania, Philadelphia, PA, United States
- Department of Nephrology, The University of Pennsylvania, Philadelphia, PA, United States
| | - Katalin Susztak
- Department of Genetics, The University of Pennsylvania, Philadelphia, PA, United States
- Department of Nephrology, The University of Pennsylvania, Philadelphia, PA, United States
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161
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Tan Q, He L, Meng X, Wang W, Pan H, Yin W, Zhu T, Huang X, Shan H. Macrophage biomimetic nanocarriers for anti-inflammation and targeted antiviral treatment in COVID-19. J Nanobiotechnology 2021; 19:173. [PMID: 34112203 PMCID: PMC8190731 DOI: 10.1186/s12951-021-00926-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/03/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The worldwide pandemic of COVID-19 remains a serious public health menace as the lack of efficacious treatments. Cytokine storm syndrome (CSS) characterized with elevated inflammation and multi-organs failure is closely correlated with the bad outcome of COVID-19. Hence, inhibit the process of CSS by controlling excessive inflammation is considered one of the most promising ways for COVID-19 treatment. RESULTS Here, we developed a biomimetic nanocarrier based drug delivery system against COVID-19 via anti-inflammation and antiviral treatment simultaneously. Firstly, lopinavir (LPV) as model antiviral drug was loaded in the polymeric nanoparticles (PLGA-LPV NPs). Afterwards, macrophage membranes were coated on the PLGA-LPV NPs to constitute drugs loaded macrophage biomimetic nanocarriers (PLGA-LPV@M). In the study, PLGA-LPV@M could neutralize multiple proinflammatory cytokines and effectively suppress the activation of macrophages and neutrophils. Furthermore, the formation of NETs induced by COVID-19 patients serum could be reduced by PLGA-LPV@M as well. In a mouse model of coronavirus infection, PLGA-LPV@M exhibited significant targeted ability to inflammation sites, and superior therapeutic efficacy in inflammation alleviation and tissues viral loads reduction. CONCLUSION Collectively, such macrophage biomimetic nanocarriers based drug delivery system showed favorable anti-inflammation and targeted antiviral effects, which may possess a comprehensive therapeutic value in COVID-19 treatment.
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Affiliation(s)
- Qingqin Tan
- Center for Infection and Immunity, Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China.,Southern Marine Science and Engineering Guangdong Laboratory, Zhuhai, 519000, Guangdong, China.,Key Laboratory of Tropical Diseases Control, Ministry of Education, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
| | - Lingjie He
- Center for Infection and Immunity, Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China.,Southern Marine Science and Engineering Guangdong Laboratory, Zhuhai, 519000, Guangdong, China.,Key Laboratory of Tropical Diseases Control, Ministry of Education, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
| | - Xiaojun Meng
- Department of Endocrinology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Wei Wang
- Center for Infection and Immunity, Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Hudan Pan
- Dr. Neher's Biophysics Laboratory for Innovative Drug Discovery, State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macao, 999078, China
| | - Weiguo Yin
- The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, 511518, Guangdong, China
| | - Tianchuan Zhu
- Center for Infection and Immunity, Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Xi Huang
- Center for Infection and Immunity, Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China. .,Southern Marine Science and Engineering Guangdong Laboratory, Zhuhai, 519000, Guangdong, China. .,Key Laboratory of Tropical Diseases Control, Ministry of Education, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China. .,The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, 511518, Guangdong, China.
| | - Hong Shan
- Center for Infection and Immunity, Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China.
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Wang MK, Yue HY, Cai J, Zhai YJ, Peng JH, Hui JF, Hou DY, Li WP, Yang JS. COVID-19 and the digestive system: A comprehensive review. World J Clin Cases 2021; 9:3796-3813. [PMID: 34141737 PMCID: PMC8180220 DOI: 10.12998/wjcc.v9.i16.3796] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/10/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is spreading at an alarming rate, and it has created an unprecedented health emergency threatening tens of millions of people worldwide. Previous studies have indicated that SARS-CoV-2 ribonucleic acid could be detected in the feces of patients even after smear-negative respiratory samples. However, demonstration of confirmed fecal-oral transmission has been difficult. Clinical studies have shown an incidence rate of gastrointestinal (GI) symptoms ranging from 2% to 79.1% in patients with COVID-19. They may precede or accompany respiratory symptoms. The most common GI symptoms included nausea, diarrhea, and abdominal pain. In addition, some patients also had liver injury, pancreatic damage, and even acute mesenteric ischemia/thrombosis. Although the incidence rates reported in different centers were quite different, the digestive system was the clinical component of the COVID-19 section. Studies have shown that angiotensin-converting enzyme 2, the receptor of SARS-CoV-2, was not only expressed in the lungs, but also in the upper esophagus, small intestine, liver, and colon. The possible mechanism of GI symptoms in COVID-19 patients may include direct viral invasion into target cells, dysregulation of angiotensin-converting enzyme 2, immune-mediated tissue injury, and gut dysbiosis caused by microbiota. Additionally, numerous experiences, guidelines, recommendations, and position statements were published or released by different organizations and societies worldwide to optimize the management practice of outpatients, inpatients, and endoscopy in the era of COVID-19. In this review, based on our previous work and relevant literature, we mainly discuss potential fecal-oral transmission, GI manifestations, abdominal imaging findings, relevant pathophysiological mechanisms, and infection control and prevention measures in the time of COVID-19.
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Affiliation(s)
- Ming-Ke Wang
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Hai-Yan Yue
- Department of Digestive Diseases, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Jin Cai
- Department of Geriatrics, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
- Department of Infectious Diseases, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Yu-Jia Zhai
- Department of Outpatient Services, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Jian-Hui Peng
- Department of Quality Management, Guangdong Second Provincial General Hospital (Pazhou Campus), Guangzhou 510317, Guangdong Province, China
| | - Ju-Fen Hui
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Deng-Yong Hou
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Wei-Peng Li
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Ji-Shun Yang
- Medical Care Center, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
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163
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Sridhar S, Nicholls J. Pathophysiology of infection with SARS-CoV-2-What is known and what remains a mystery. Respirology 2021; 26:652-665. [PMID: 34041821 PMCID: PMC8242464 DOI: 10.1111/resp.14091] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/03/2021] [Indexed: 12/12/2022]
Abstract
Coronavirus disease 2019 (COVID‐19), caused by coronavirus severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), has caused extensive disruption and mortality since its recent emergence. Concomitantly, there has been a race to understand the virus and its pathophysiology. The clinical manifestations of COVID‐19 are manifold and not restricted to the respiratory tract. Extrapulmonary manifestations involving the gastrointestinal tract, hepatobiliary system, cardiovascular and renal systems have been widely reported. However, the pathophysiology of many of these manifestations is controversial with questionable support for direct viral invasion and an abundance of alternative explanations such as pre‐existing medical conditions and critical illness. Prior research on SARS‐Co‐V and NL63 was rapidly leveraged to identify angiotensin‐converting enzyme 2 (ACE2) receptor as the key cell surface receptor for SARS‐CoV‐2. The distribution of ACE2 has been used as a starting point for estimating vulnerability of various tissue types to SARS‐CoV‐2 infection. Sophisticated organoid and animal models have been used to demonstrate such infectivity of extrapulmonary tissues in vitro, but the clinical relevance of these findings remains uncertain. Clinical autopsy studies are typically small and inevitably biased towards patients with severe COVID‐19 and prolonged hospitalization. Technical issues such as delay between time of death and autopsy, use of inappropriate antibodies for paraffin‐embedded tissue sections and misinterpretation of cellular structures as virus particles on electron micrograph images are additional problems encountered in the extant literature. Given that SARS‐CoV‐2 is likely to circulate permanently in human populations, there is no doubt that further work is required to clarify the pathobiology of COVID‐19.
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Affiliation(s)
- Siddharth Sridhar
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - John Nicholls
- Department of Pathology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
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164
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Chornenkyy Y, Mejia-Bautista M, Brucal M, Blanke T, Dittmann D, Yeldandi A, Boike JR, Lomasney JW, Nayar R, Jennings LJ, Pezhouh MK. Liver Pathology and SARS-CoV-2 Detection in Formalin-Fixed Tissue of Patients With COVID-19. Am J Clin Pathol 2021; 155:802-814. [PMID: 33914058 PMCID: PMC8135761 DOI: 10.1093/ajcp/aqab009] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objectives The novel coronavirus, severe acute respiratory syndrome coronavirus 2, causing coronavirus disease 2019 (COVID-19) remains a global health threat and a significant source of human morbidity and mortality. While the virus primarily induces lung injury, it also has been reported to cause hepatic sequelae. Methods We aimed to detect the virus in formalin-fixed tissue blocks and document the liver injury patterns in patients with COVID-19 compared with a control group. Results We were able to detect viral RNA in the bronchioalveolar cell blocks (12/12, 100%) and formalin-fixed, paraffin-embedded tissue of the lung (8/8, 100%) and liver (4/9, 44%) of patients with COVID-19. Although the peak values of the main liver enzymes and bilirubin were higher in the patients with COVID-19 compared with the control group, the differences were not significant. The main histologic findings were minimal to focal mild portal tract chronic inflammation (7/8, 88%, P < .05) and mild focal lobular activity (6/8, 75%, P = .06). Conclusions We found that most patients who died of COVID-19 had evidence of mild focal hepatitis clinically and histologically; however, the virus was detected in less than half of the cases.
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Affiliation(s)
| | | | | | | | | | | | | | - Jon W Lomasney
- Departments of Pathology, Chicago, IL, USA
- Pharmacology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Ritu Nayar
- Departments of Pathology, Chicago, IL, USA
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165
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Sahu KK, Cerny J. A review on how to do hematology consults during COVID-19 pandemic. Blood Rev 2021; 47:100777. [PMID: 33199084 PMCID: PMC7648889 DOI: 10.1016/j.blre.2020.100777] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/25/2020] [Accepted: 11/04/2020] [Indexed: 01/08/2023]
Abstract
The ongoing COVID-19 pandemic is the most trending and talked topic across the World. From its point of origin in Wuhan, China to clinical laboratory at NIH, a mere six-month-old SARS-CoV-2 virus is keeping the clinicians, and scientists busy at various fronts. However, COVID-19 is an emerging and evolving disease and each day brings in more data, new figures, and findings from the field of clinical practice. The role of hematologists has been increasingly recognized during the current pandemic because of several reasons. Most important of them are the characteristic hematological findings of COVID-19 patients that also have prognostic implications and that were not seen in other viral infections. The treatment of hematological complications in COVID-19 patients is very challenging given the critical care setting. There are interim and limited guidelines thus far due to the novelty of the disease. As this remains to be a quite fluid situation, all the appropriate medical societies including the major hematology bodies are proposing initial and interim guidelines (e.g. ASH guideline). This puts a hematologist on consult service in a dubious position where, he/she must tailor the recommendations on case to case basis. The purpose of this review is to provide the background context about the impact of COVID-19 on the blood system and to summarize the current interim guidelines to manage the associated hematological issues in COVID-19 infection.
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Affiliation(s)
- Kamal Kant Sahu
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, USA
| | - Jan Cerny
- Division of Hematology and Oncology, Department of Medicine, UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, MA, USA.
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Marjot T, Webb GJ, Barritt AS, Moon AM, Stamataki Z, Wong VW, Barnes E. COVID-19 and liver disease: mechanistic and clinical perspectives. Nat Rev Gastroenterol Hepatol 2021; 18:348-364. [PMID: 33692570 PMCID: PMC7945972 DOI: 10.1038/s41575-021-00426-4] [Citation(s) in RCA: 229] [Impact Index Per Article: 76.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 02/06/2023]
Abstract
Our understanding of the hepatic consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and its resultant coronavirus disease 2019 (COVID-19) has evolved rapidly since the onset of the pandemic. In this Review, we discuss the hepatotropism of SARS-CoV-2, including the differential expression of viral receptors on liver cell types, and we describe the liver histology features present in patients with COVID-19. We also provide an overview of the pattern and relevance of abnormal liver biochemistry during COVID-19 and present the possible underlying direct and indirect mechanisms for liver injury. Furthermore, large international cohorts have been able to characterize the disease course of COVID-19 in patients with pre-existing chronic liver disease. Patients with cirrhosis have particularly high rates of hepatic decompensation and death following SARS-CoV-2 infection and we outline hypotheses to explain these findings, including the possible role of cirrhosis-associated immune dysfunction. This finding contrasts with outcome data in pharmacologically immunosuppressed patients after liver transplantation who seem to have comparatively better outcomes from COVID-19 than those with advanced liver disease. Finally, we discuss the approach to SARS-CoV-2 vaccination in patients with cirrhosis and after liver transplantation and predict how changes in social behaviours and clinical care pathways during the pandemic might lead to increased liver disease incidence and severity.
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Affiliation(s)
- Thomas Marjot
- Oxford Liver Unit, Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, UK.
| | - Gwilym J Webb
- Cambridge Liver Unit, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Alfred S Barritt
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - Andrew M Moon
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - Zania Stamataki
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Vincent W Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Eleanor Barnes
- Oxford Liver Unit, Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, UK.
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167
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Fahmy OH, Daas FM, Salunkhe V, Petrey JL, Cosar EF, Ramirez J, Akca O. Is Microthrombosis the Main Pathology in Coronavirus Disease 2019 Severity?-A Systematic Review of the Postmortem Pathologic Findings. Crit Care Explor 2021; 3:e0427. [PMID: 34036278 PMCID: PMC8140776 DOI: 10.1097/cce.0000000000000427] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This systematic review attempts to retrieve and report the findings of postmortem studies including the histopathologic data of deceased coronavirus disease 2019 patients and to review the manifestations of coronavirus disease 2019-associated thrombotic pathologies reported in the recent literature. DATA SOURCES PubMed, Excerpta Medica Database, and Cochrane library between December 1, 2019, and August 26, 2020. STUDY SELECTION Investigators screened 360 unique references, retrieved published autopsy series, and report on the postmortem histopathologic information on patients who had died of coronavirus disease 2019. DATA EXTRACTION Investigators independently abstracted all available data including study design, participant demographics, key histopathologic findings, disease severity markers, duration of hospital stay, and cause of death. DATA SYNTHESIS From the 65 eligible studies, 691 total completed autopsies were included in evidence synthesis. Histopathologic evaluation of the lungs revealed presence of diffuse alveolar damage in 323 of 443 patients and pulmonary microthrombi in 242 of 326 patients. Deep venous thrombosis and pulmonary embolism were found in 41% and ~15%, respectively, of the cadavers examined for thromboembolic events. d-dimer levels were generally higher in patients with severe clinical course of coronavirus disease 2019. Plasma levels of ferritin, lactate dehydrogenase, interleukin-6, and C-reactive protein were higher in nonsurvivors when compared with survivors. Overall, microthrombi and extensive angiogenesis of lung vasculature were the most common pathologic findings in the lungs and microthrombi in most of the assessed organ-tissue. CONCLUSIONS Diffuse alveolar damage was the most predominant feature in the lungs of coronavirus disease 2019 patients who underwent postmortem assessment. Widespread pulmonary microthrombosis and extensive pulmonary angiogenesis, in addition to frequent pulmonary and extrapulmonary microthrombotic and thromboembolic findings in patients with coronavirus disease 2019, appear to be consistent with the disease-specific hypercoagulability. Further discovery efforts in assessing the link between coronavirus disease 2019, hypercoagulable state, and immunothrombosis are warranted. In the interim, increased attention to anticoagulant treatment approaches in coronavirus disease 2019 patients is needed.
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Affiliation(s)
- Omar H Fahmy
- Division of Infectious Diseases, University of Louisville School of Medicine, Louisville, KY
- Center of Excellence for Research in Infectious Diseases, University of Louisville School of Medicine, Louisville, KY
| | - Farah M Daas
- Division of Infectious Diseases, University of Louisville School of Medicine, Louisville, KY
- Center of Excellence for Research in Infectious Diseases, University of Louisville School of Medicine, Louisville, KY
| | - Vidyulata Salunkhe
- Division of Infectious Diseases, University of Louisville School of Medicine, Louisville, KY
- Center of Excellence for Research in Infectious Diseases, University of Louisville School of Medicine, Louisville, KY
| | - Jessica L Petrey
- Kornhauser Health Sciences Library, University of Louisville, Louisville, KY
| | - Ediz F Cosar
- Department of Pathology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA
| | - Julio Ramirez
- Division of Infectious Diseases, University of Louisville School of Medicine, Louisville, KY
- Center of Excellence for Research in Infectious Diseases, University of Louisville School of Medicine, Louisville, KY
| | - Ozan Akca
- Departments of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, Louisville, KY
- Comprehensive Stroke Clinical Research Program (CSCRP), University of Louisville School of Medicine, Louisville, KY
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168
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Duarte-Neto AN, Caldini EG, Gomes-Gouvêa MS, Kanamura CT, de Almeida Monteiro RA, Ferranti JF, Ventura AMC, Regalio FA, Fiorenzano DM, Gibelli MABC, Carvalho WBD, Leal GN, Pinho JRR, Delgado AF, Carneiro-Sampaio M, Mauad T, Ferraz da Silva LF, Saldiva PHN, Dolhnikoff M. An autopsy study of the spectrum of severe COVID-19 in children: From SARS to different phenotypes of MIS-C. EClinicalMedicine 2021; 35:100850. [PMID: 33937731 PMCID: PMC8072136 DOI: 10.1016/j.eclinm.2021.100850] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND COVID-19 in children is usually mild or asymptomatic, but severe and fatal paediatric cases have been described. The pathology of COVID-19 in children is not known; the proposed pathogenesis for severe cases includes immune-mediated mechanisms or the direct effect of SARS-CoV-2 on tissues. We describe the autopsy findings in five cases of paediatric COVID-19 and provide mechanistic insight into the mechanisms involved in the pathogenesis of the disease. METHODS Children and adolescents who died with COVID-19 between March 18 and August 15, 2020 were autopsied with a minimally invasive method. Tissue samples from all vital organs were analysed by histology, electron microscopy (EM), reverse-transcription polymerase chain reaction (RT-PCR) and immunohistochemistry (IHC). FINDINGS Five patients were included, one male and four female, aged 7 months to 15 years. Two patients had severe diseases before SARS-CoV-2 infection: adrenal carcinoma and Edwards syndrome. Three patients were previously healthy and had multisystem inflammatory syndrome in children (MIS-C) with distinct clinical presentations: myocarditis, colitis, and acute encephalopathy with status epilepticus. Autopsy findings varied amongst patients and included mild to severe COVID-19 pneumonia, pulmonary microthrombosis, cerebral oedema with reactive gliosis, myocarditis, intestinal inflammation, and haemophagocytosis. SARS-CoV-2 was detected in all patients in lungs, heart and kidneys by at least one method (RT-PCR, IHC or EM), and in endothelial cells from heart and brain in two patients with MIS-C (IHC). In addition, we show for the first time the presence of SARS-CoV-2 in the brain tissue of a child with MIS-C with acute encephalopathy, and in the intestinal tissue of a child with acute colitis. Interpretation: SARS-CoV-2 can infect several cell and tissue types in paediatric patients, and the target organ for the clinical manifestation varies amongst individuals. Two major patterns of severe COVID-19 were observed: a primarily pulmonary disease, with severe acute respiratory disease and diffuse alveolar damage, or a multisystem inflammatory syndrome with the involvement of several organs. The presence of SARS-CoV-2 in several organs, associated with cellular ultrastructural changes, reinforces the hypothesis that a direct effect of SARS-CoV-2 on tissues is involved in the pathogenesis of MIS-C. FUNDING Fundação de Amparo à Pesquisa do Estado de São Paulo, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Bill and Melinda Gates Foundation.
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Affiliation(s)
- Amaro Nunes Duarte-Neto
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo. Av. Dr. Arnaldo, 455, 01246-903 São Paulo, SP, Brasil
- Instituto Adolfo Lutz. Av. Dr. Arnaldo, 351, 01246-000 São Paulo, SP, Brasil
| | - Elia Garcia Caldini
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo. Av. Dr. Arnaldo, 455, 01246-903 São Paulo, SP, Brasil
| | - Michele Soares Gomes-Gouvêa
- Departamento de Gastroenterologia, LIM 07, Faculdade de Medicina da Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 500, 05403-000 São Paulo, SP, Brasil
| | | | | | - Juliana Ferreira Ferranti
- Instituto da Criança, Departamento de Pediatria, Faculdade de Medicina da Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 647, 05403-000 São Paulo, SP, Brasil
| | - Andrea Maria Cordeiro Ventura
- Unidade de Terapia Intensiva Pediátrica, Departamento de Pediatria, Hospital Universitário da Universidade de São Paulo. Av. Prof. Lineu Prestes, 2565, 05508-000 São Paulo, SP, Brasil
| | - Fabiane Aliotti Regalio
- Divisão de Anestesia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Av. Dr Enéas de Carvalho Aguiar, 255, 01246-000 São Paulo, SP, Brasil
| | - Daniela Matos Fiorenzano
- Instituto da Criança, Departamento de Pediatria, Faculdade de Medicina da Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 647, 05403-000 São Paulo, SP, Brasil
| | - Maria Augusta Bento Cicaroni Gibelli
- Instituto da Criança, Departamento de Pediatria, Faculdade de Medicina da Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 647, 05403-000 São Paulo, SP, Brasil
| | - Werther Brunow de Carvalho
- Instituto da Criança, Departamento de Pediatria, Faculdade de Medicina da Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 647, 05403-000 São Paulo, SP, Brasil
| | - Gabriela Nunes Leal
- Instituto da Criança, Departamento de Pediatria, Faculdade de Medicina da Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 647, 05403-000 São Paulo, SP, Brasil
| | - João Renato Rebello Pinho
- Departamento de Gastroenterologia, LIM 07, Faculdade de Medicina da Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 500, 05403-000 São Paulo, SP, Brasil
| | - Artur Figueiredo Delgado
- Instituto da Criança, Departamento de Pediatria, Faculdade de Medicina da Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 647, 05403-000 São Paulo, SP, Brasil
| | - Magda Carneiro-Sampaio
- Instituto da Criança, Departamento de Pediatria, Faculdade de Medicina da Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 647, 05403-000 São Paulo, SP, Brasil
| | - Thais Mauad
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo. Av. Dr. Arnaldo, 455, 01246-903 São Paulo, SP, Brasil
| | - Luiz Fernando Ferraz da Silva
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo. Av. Dr. Arnaldo, 455, 01246-903 São Paulo, SP, Brasil
- Serviço de Verificação de Óbitos da Capital, Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 250, 05403-000 São Paulo, SP, Brasil
| | - Paulo Hilario Nascimento Saldiva
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo. Av. Dr. Arnaldo, 455, 01246-903 São Paulo, SP, Brasil
| | - Marisa Dolhnikoff
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo. Av. Dr. Arnaldo, 455, 01246-903 São Paulo, SP, Brasil
- Corresponding author at: Faculdade de Medicina da Universidade de São Paulo, Departamento de Patologia. Av. Dr. Arnaldo, 455, sala 1155 – Cerqueira Cesar, Sao Paulo, SP 01246-903, Brasil.
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Elhence A, Vaishnav M, Biswas S, Chauhan A, Anand A, Shalimar. Coronavirus Disease-2019 (COVID-19) and the Liver. J Clin Transl Hepatol 2021; 9:247-255. [PMID: 34007807 PMCID: PMC8111098 DOI: 10.14218/jcth.2021.00006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/05/2021] [Accepted: 02/26/2021] [Indexed: 01/08/2023] Open
Abstract
Within a year of its emergence, coronavirus disease-2019 (COVID-19) has evolved into a pandemic. What has emerged during the past 1 year is that, apart from its potentially fatal respiratory presentation from which the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) derives its name, it presents with a myriad of gastrointestinal (GI) and liver manifestations. Expression of the angiotensin-converting enzyme-2 (ACE-2) receptor throughout the GI tract and liver, which is the receptor for the SARS-CoV-2, may be responsible for the GI and liver manifestations. Besides acting directly via the ACE-2 receptor, the virus triggers a potent immune response, which might have a role in pathogenesis. The virus leads to derangement in liver function tests in close to 50% of the patients. The impact of these derangements in patients with a normal underlying liver seems to be innocuous. Severe clinical presentations include acute decompensation and acute-on-chronic liver failure in a patient with chronic liver disease, leading to high mortality. Evolving data suggests that, contrary to intuition, liver transplant recipients and patients with autoimmune liver disease on immunosuppression do not have increased mortality. The exact mechanism underlying why immunosuppressed patients fare well as compared to other patients remains to be deciphered. With newer variants of COVID-19, which can spread faster than the original strain, the data on hepatic manifestations needs to be updated to keep a step ahead of the virus.
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Affiliation(s)
- Anshuman Elhence
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Manas Vaishnav
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Sagnik Biswas
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Chauhan
- Department of Gastroenterology, Indira Gandhi Medical College, Shimla, India
| | - Abhinav Anand
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Shalimar
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
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170
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Liver histopathology in COVID-19 patients: A mono-Institutional series of liver biopsies and autopsy specimens. Pathol Res Pract 2021; 221:153451. [PMID: 33932720 PMCID: PMC8054534 DOI: 10.1016/j.prp.2021.153451] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 12/24/2022]
Abstract
Few studies have focused on COVID-19 patients’ hepatic histopathological features. Many of the described morphological landscapes are non-specific and possibly due to other comorbidities or to Sars-CoV-2-related therapies. We describe the hepatic histopathological findings of 3 liver biopsies obtained from living COVID-19 patients in which active SARS-CoV-2 infection was molecularly confirmed and biopsied because of significant alterations of liver function tests and 25 livers analyzed during COVID-19-related autopsies. Main histopathological findings were (i) the absence of significant biliary tree or vascular damages, (ii) mild/absent lymphocytic hepatitis; (iii) activation of (pigmented) Kupffer cells, (iv) hepatocellular regenerative changes, (v) the presence of steatosis, (vi) sinusoidal ectasia, micro-thrombosis and acinar atrophy in autopsy specimens No viral particle actively infecting the hepatic or endothelial cells was detected at in situ hybridization. The morphological features observed within the hepatic parenchyma are not specific and should be considered as the result of an indirect insult resulting from the viral infection or the adopted therapeutic protocols.
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171
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Mondello C, Roccuzzo S, Malfa O, Sapienza D, Gualniera P, Ventura Spagnolo E, Di Nunno N, Salerno M, Pomara C, Asmundo A. Pathological Findings in COVID-19 as a Tool to Define SARS-CoV-2 Pathogenesis. A Systematic Review. Front Pharmacol 2021; 12:614586. [PMID: 33867981 PMCID: PMC8047201 DOI: 10.3389/fphar.2021.614586] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/14/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction: The World Health Organization declared the COVID-19 pandemic in March 2020. COVID-19 still represents a worldwide health emergency, which causesa severe disease that has led to the death of many patients. The pathophysiological mechanism of SARS-CoV-2 determining the tissue damage is not clear and autopsycan be auseful tool to improve the knowledge of this infection and, thus, it can help achieve a timely diagnosis and develop an appropriate therapy. This is an overview of the main post-mortem findings reporting data on the infection effects on several organs. Methods: A systematic literature search was conducted in the PubMed database searching for articles from 1 January to August 31, 2020. Thearticles were selected identifying words/concepts in the titles and/or abstracts that indicated the analysis of the morphological/pathological tissue injuries related to SARS-CoV-2 disease by several investigations. Results: A total of 63 articles were selected. The main investigated tissue was the lung showing a diffuse alveolar damage (DAD) frequently associated with pulmonary thrombotic microangiopathy. Inflammatory findings and vascular damage were observed in other organs such as heart, liver, kidney, brain, spleen, skin and adrenal gland. The immunohistochemical analysis showed tissue inflammatory cells infiltrates. The virus presence was detected by several investigations such as RT-PCR, immunohistochemistry and electron microscope, showing the effect ofSARS-CoV-2not exclusively in the lung. Discussion: The evidence emerging from this review highlighted the importance of autopsy to provide a fundamental base in the process of understanding the consequences ofSARS-CoV-2 infection. COVID-19 is strictly related to a hyper inflammatory state that seems to start with DAD and immuno-thrombotic microangiopathy. Massive activation of the immune system and microvascular damage might also be responsible for indirect damage to other organs, even if the direct effect of the virus on these tissues cannot be excluded.
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Affiliation(s)
- Cristina Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Salvatore Roccuzzo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Orazio Malfa
- Institute of Legal Medicine and Department of Surgical and Medical Sciences, University “Magna Graecia”, Catanzaro, Italy
| | - Daniela Sapienza
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Patrizia Gualniera
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Elvira Ventura Spagnolo
- Section of Legal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Nunzio Di Nunno
- Department of History, Society and Studies on Humanity, University of Salento, Lecce, Italy
| | - Monica Salerno
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, Catania, Italy
| | - Cristoforo Pomara
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, Catania, Italy
| | - Alessio Asmundo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
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172
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Sessa F, Salerno M, Pomara C. Autopsy Tool in Unknown Diseases: The Experience with Coronaviruses (SARS-CoV, MERS-CoV, SARS-CoV-2). MEDICINA (KAUNAS, LITHUANIA) 2021; 57:309. [PMID: 33806100 PMCID: PMC8064502 DOI: 10.3390/medicina57040309] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/15/2021] [Accepted: 03/22/2021] [Indexed: 02/07/2023]
Abstract
In the last two decades, three unknown pathogens have caused outbreaks, generating severe global health concerns. In 2003, after nucleic acid genotyping, a new virus was named severe acute respiratory syndrome coronavirus (SARS-CoV). After nine years, another coronavirus emerged in the middle east and was named MERS-CoV (Middle East Respiratory Syndrome-Coronavirus). Finally, in December 2019, a new unknown coronavirus was isolated from a cluster of patients and was named SARS-CoV-2 (COVID-19, coronavirus disease 2019). This review aims to propose a complete overview of autopsy in the three coronaviruses over the past two decades, showing its pivotal role in the management of unknown diseases. A total of 116 studies fulfilled the inclusion criteria: 14 studies were collected concerning SARS-CoV (87 autopsy reports, from Asian and American countries), 2 studies for MERS-CoV (2 autopsy reports, from Middle-East Asian countries), and 100 studies on SARS-CoV-2 (930 autopsy reports). Analyzing the data obtained on COVID-19, based on the country criterion, a large number of post-mortem investigation were performed in European countries (580 reports), followed by American countries (251 reports). It is interesting to note that no data were found from the Oceanic countries, maybe because of the minor involvement of the outbreak. In all cases, autopsy provided much information about each unknown coronavirus. Despite advanced technologies in the diagnostic fields, to date, autopsy remains the gold standard method to understand the biological features and the pathogenesis of unknown infections, especially when awareness of a pathogen is restricted and the impact on the healthcare system is substantial. The knowledge gained through this technique may positively influence therapeutic strategies, ultimately reducing mortality.
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Affiliation(s)
- Francesco Sessa
- Department of Clinical and Experimental Medicine, Institute of Legal Medicine, University of Foggia, 71122 Foggia, Italy
| | - Monica Salerno
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, Institute of Legal Medicine, University of Catania, 95121 Catania, Italy;
| | - Cristoforo Pomara
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, Institute of Legal Medicine, University of Catania, 95121 Catania, Italy;
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173
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COVID-19 and the liver: an adverse outcome pathway perspective. Toxicology 2021; 455:152765. [PMID: 33771662 PMCID: PMC7986318 DOI: 10.1016/j.tox.2021.152765] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/18/2021] [Accepted: 03/21/2021] [Indexed: 12/22/2022]
Abstract
Liver damage is observed in up to half of hospitalized COVID-19 patients and can result either from actions of SARS-CoV-2 as such or from pharmacological treatment. The present paper introduces an adverse outcome pathway construct that mechanistically describes the pathways induced by SARS-CoV-2 leading to liver injury. This can be caused by direct binding of the virus and local actions in cholangiocytes, but may also indirectly result from the general state of hypoxia and systemic inflammation in COVID-19 patients. Further research is urgently needed to fill remaining knowledge gaps. This will be anticipated to create a solid basis for future and more targeted development of vaccines and, in particular, therapies.
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174
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Li Y, Regan J, Fajnzylber J, Coxen K, Corry H, Wong C, Rosenthal A, Atyeo C, Fischinger S, Gillespie E, Chishti R, Baden L, Yu XG, Alter G, Kim A, Li JZ. Liver Fibrosis Index FIB-4 Is Associated With Mortality in COVID-19. Hepatol Commun 2021; 5:434-445. [PMID: 34553511 PMCID: PMC7753559 DOI: 10.1002/hep4.1650] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/27/2020] [Accepted: 11/01/2020] [Indexed: 12/11/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is associated with adverse outcomes, including need for invasive mechanical ventilation and death in people with risk factors. Liver enzyme elevation is commonly seen in this group, but its clinical significance remains elusive. In this study, we calculated the Fibrosis-4 (FIB-4) score for a cohort of hospitalized patients with COVID-19 and assessed its association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA, inflammatory cytokine levels, and clinical outcome. A total of 202 hospitalized participants who tested positive for SARS-CoV-2 by nasopharyngeal sampling were included in this analysis. FIB-4 was calculated for each participant using the alanine aminotransferase, aspartate aminotransferase, age, and platelet count. We evaluated the association between FIB-4 and mortality using both multivariate logistic regression and Cox proportional hazards model. Correlations between FIB-4 and SARS-CoV-2 RNA and cytokine levels were evaluated using the Spearman test. Among the 202 participants, 22 died. The median FIB-4 in participants who survived and died were 1.91 and 3.98 (P < 0.001 by Mann-Whitney U test), respectively. Each one-unit increment in FIB-4 was associated with an increased odds of death (odds ratio, 1.79; 95% confidence interval, 1.36, 2.35; P < 0.001) after adjusting for baseline characteristics including sex, body mass index, hypertension, diabetes, and history of liver diseases. During hospitalization, FIB-4 peaked and then normalized in the survival group but failed to normalize in the death group. FIB-4 was positively correlated with the level of SARS-CoV-2 viral load and monocyte-associated cytokines, especially interleukin-6 and interferon gamma-induced protein 10. Conclusion: FIB-4 is associated with mortality in COVID-19, independent of underlying conditions including liver diseases. FIB-4 may be a simple and inexpensive approach to risk-stratify individuals with COVID-19.
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Affiliation(s)
- Yijia Li
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - James Regan
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Jesse Fajnzylber
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Kendyll Coxen
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Heather Corry
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Colline Wong
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Alexandra Rosenthal
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Caroline Atyeo
- Ragon Institute of MGHMIT and HarvardHarvard Medical SchoolCambridgeMAUSA
| | | | - Elizabeth Gillespie
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Rida Chishti
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Lindsey Baden
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Xu G Yu
- Ragon Institute of MGHMIT and HarvardHarvard Medical SchoolCambridgeMAUSA
| | - Galit Alter
- Ragon Institute of MGHMIT and HarvardHarvard Medical SchoolCambridgeMAUSA
- Division of Infectious DiseasesMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Arthur Kim
- Division of Infectious DiseasesMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Jonathan Z Li
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
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175
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Li D, Ding X, Xie M, Tian D, Xia L. COVID-19-associated liver injury: from bedside to bench. J Gastroenterol 2021; 56:218-230. [PMID: 33527211 PMCID: PMC7849620 DOI: 10.1007/s00535-021-01760-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/04/2021] [Indexed: 02/06/2023]
Abstract
The outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been a global challenge since December 2019. Although most patients with COVID-19 exhibit mild clinical manifestations, in approximately 5% of these patients, the disease eventually progresses to severe lung injury or even multiorgan dysfunction. This situation represents various challenges to hepatology. In the context of liver injury in patients with COVID-19, several key problems need to be solved. For instance, it is important to determine whether SARS-CoV-2 can directly invade liver, especially when ACE2 appears to be negligibly expressed on hepatocytes. In addition, the mechanisms underlying liver dysfunction in COVID-19 patients are not fully understood, which are likely multifactorial and related to hyperinflammation, dysregulated immune responses, abnormal coagulation and drugs. Here, we systematically describe the potential pathogenesis of COVID-19-associated liver injury and propose several hypotheses about its etiopathogenesis.
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Affiliation(s)
- Dongxiao Li
- Department of Gastroenterology, Institute of Liver and Gastrointestinal Diseases, Hubei Key Laboratory of Hepato-Pancreato-Biliary Diseases, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, China
| | - Xiangming Ding
- Department of Gastroenterology, Henan Provincial People's Hospital, Zhengzhou, 450000, Henan Province, China
| | - Meng Xie
- Department of Gastroenterology, Institute of Liver and Gastrointestinal Diseases, Hubei Key Laboratory of Hepato-Pancreato-Biliary Diseases, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, China
| | - Dean Tian
- Department of Gastroenterology, Institute of Liver and Gastrointestinal Diseases, Hubei Key Laboratory of Hepato-Pancreato-Biliary Diseases, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, China
| | - Limin Xia
- Department of Gastroenterology, Institute of Liver and Gastrointestinal Diseases, Hubei Key Laboratory of Hepato-Pancreato-Biliary Diseases, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, China.
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176
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Stefan N, Birkenfeld AL, Schulze MB. Global pandemics interconnected - obesity, impaired metabolic health and COVID-19. Nat Rev Endocrinol 2021; 17:135-149. [PMID: 33479538 DOI: 10.1038/s41574-020-00462-1] [Citation(s) in RCA: 265] [Impact Index Per Article: 88.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2020] [Indexed: 02/07/2023]
Abstract
Obesity and impaired metabolic health are established risk factors for the non-communicable diseases (NCDs) type 2 diabetes mellitus, cardiovascular disease, neurodegenerative diseases, cancer and nonalcoholic fatty liver disease, otherwise known as metabolic associated fatty liver disease (MAFLD). With the worldwide spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), obesity and impaired metabolic health also emerged as important determinants of severe coronavirus disease 2019 (COVID-19). Furthermore, novel findings indicate that specifically visceral obesity and characteristics of impaired metabolic health such as hyperglycaemia, hypertension and subclinical inflammation are associated with a high risk of severe COVID-19. In this Review, we highlight how obesity and impaired metabolic health increase complications and mortality in COVID-19. We also summarize the consequences of SARS-CoV-2 infection for organ function and risk of NCDs. In addition, we discuss data indicating that the COVID-19 pandemic could have serious consequences for the obesity epidemic. As obesity and impaired metabolic health are both accelerators and consequences of severe COVID-19, and might adversely influence the efficacy of COVID-19 vaccines, we propose strategies for the prevention and treatment of obesity and impaired metabolic health on a clinical and population level, particularly while the COVID-19 pandemic is present.
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Affiliation(s)
- Norbert Stefan
- Institute of Diabetes Research and Metabolic Diseases (IDM), the Helmholtz Center, Munich, Germany.
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology and Nephrology, University Hospital of Tübingen, Tübingen, Germany.
- German Center for Diabetes Research (DZD), Neuherberg, Germany.
| | - Andreas L Birkenfeld
- Institute of Diabetes Research and Metabolic Diseases (IDM), the Helmholtz Center, Munich, Germany
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology and Nephrology, University Hospital of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Department of Diabetes, School of Life Course Science, King's College London, London, UK
| | - Matthias B Schulze
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
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177
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Marjot T, Moon AM, Cook JA, Abd-Elsalam S, Aloman C, Armstrong MJ, Pose E, Brenner EJ, Cargill T, Catana MA, Dhanasekaran R, Eshraghian A, García-Juárez I, Gill US, Jones PD, Kennedy J, Marshall A, Matthews C, Mells G, Mercer C, Perumalswami PV, Avitabile E, Qi X, Su F, Ufere NN, Wong YJ, Zheng MH, Barnes E, Barritt AS, Webb GJ. Outcomes following SARS-CoV-2 infection in patients with chronic liver disease: An international registry study. J Hepatol 2021; 74:567-577. [PMID: 33035628 PMCID: PMC7536538 DOI: 10.1016/j.jhep.2020.09.024] [Citation(s) in RCA: 335] [Impact Index Per Article: 111.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Chronic liver disease (CLD) and cirrhosis are associated with immune dysregulation, leading to concerns that affected patients may be at risk of adverse outcomes following SARS-CoV-2 infection. We aimed to determine the impact of COVID-19 on patients with pre-existing liver disease, which currently remains ill-defined. METHODS Between 25th March and 8th July 2020, data on 745 patients with CLD and SARS-CoV-2 (including 386 with and 359 without cirrhosis) were collected by 2 international registries and compared to data on non-CLD patients with SARS-CoV-2 from a UK hospital network. RESULTS Mortality was 32% in patients with cirrhosis compared to 8% in those without (p <0.001). Mortality in patients with cirrhosis increased according to Child-Pugh class (A [19%], B [35%], C [51%]) and the main cause of death was from respiratory failure (71%). After adjusting for baseline characteristics, factors associated with death in the total CLD cohort were age (odds ratio [OR] 1.02; 1.01-1.04), Child-Pugh A (OR 1.90; 1.03-3.52), B (OR 4.14; 2.4-7.65), or C (OR 9.32; 4.80-18.08) cirrhosis and alcohol-related liver disease (OR 1.79; 1.03-3.13). Compared to patients without CLD (n = 620), propensity-score-matched analysis revealed significant increases in mortality in those with Child-Pugh B (+20.0% [8.8%-31.3%]) and C (+38.1% [27.1%-49.2%]) cirrhosis. Acute hepatic decompensation occurred in 46% of patients with cirrhosis, of whom 21% had no respiratory symptoms. Half of those with hepatic decompensation had acute-on-chronic liver failure. CONCLUSIONS In the largest such cohort to date, we demonstrate that baseline liver disease stage and alcohol-related liver disease are independent risk factors for death from COVID-19. These data have important implications for the risk stratification of patients with CLD across the globe during the COVID-19 pandemic. LAY SUMMARY This international registry study demonstrates that patients with cirrhosis are at increased risk of death from COVID-19. Mortality from COVID-19 was particularly high among patients with more advanced cirrhosis and those with alcohol-related liver disease.
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Affiliation(s)
- Thomas Marjot
- Oxford Liver Unit, Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, UK.
| | - Andrew M Moon
- Division of Gastroenterology and Hepatology, University of North Carolina, North Carolina, USA
| | - Jonathan A Cook
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Sherief Abd-Elsalam
- Tropical Medicine and Infectious diseases Department, Tanta University, Tanta, Egypt
| | - Costica Aloman
- Department of Medicine, Section of Hepatology, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Elisa Pose
- Liver Unit, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Erica J Brenner
- Division of Pediatric Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Tamsin Cargill
- Oxford Liver Unit, Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, UK
| | - Maria-Andreea Catana
- Division of Gastroenterology/Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Renumathy Dhanasekaran
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ahad Eshraghian
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz, Iran
| | - Ignacio García-Juárez
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Upkar S Gill
- Barts Liver Centre, Barts Health NHS Trust & Barts & The London School of Medicine & Dentistry, QMUL, London, UK
| | - Patricia D Jones
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - James Kennedy
- Oxford Liver Unit, Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, UK
| | | | - Charmaine Matthews
- Department of Gastroenterology and Hepatology, Royal Liverpool Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - George Mells
- Cambridge Liver Unit, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Carolyn Mercer
- Oxford Liver Unit, Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, UK
| | - Ponni V Perumalswami
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Emma Avitabile
- Liver Unit, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Barcelona, Spain
| | - Xialong Qi
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
| | - Feng Su
- Division of Gastroenterology, University of Washington, Seattle, WA, USA
| | - Nneka N Ufere
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yu Jun Wong
- Department of Gastroenterology & Hepatology, Changi General Hospital Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ming-Hua Zheng
- MAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Key Laboratory of Diagnosis and Treatment for The Development of Chronic Liver Disease, Zhejiang Province, Wenzhou, Zhejiang, China
| | - Eleanor Barnes
- Oxford Liver Unit, Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, UK
| | - Alfred S Barritt
- Division of Gastroenterology and Hepatology, University of North Carolina, North Carolina, USA
| | - Gwilym J Webb
- Oxford Liver Unit, Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, UK; Cambridge Liver Unit, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
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178
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Espinoza JAL, Júnior JE, Miranda CH. Atypical COVID-19 presentation with Budd-Chiari syndrome leading to an outbreak in the emergency department. Am J Emerg Med 2021; 46:800.e5-800.e7. [PMID: 33573853 PMCID: PMC7849468 DOI: 10.1016/j.ajem.2021.01.090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
We described a case report of a 50 years-old-woman admitted to the emergency department with abdominal pain associated with febrile hepatosplenomegaly with the final diagnosis of suprahepatic vein thrombosis secondary to COVID-19. Initially, this patient stayed out of a private room because of this atypical presentation and caused a COVID-19 outbreak in the emergency department.
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Affiliation(s)
- Javier Alejandro Lecca Espinoza
- Division of Medical Imaging, Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto School of Medicine, São Paulo University, Ribeirão Preto, SP, Brazil
| | - Jorge Elias Júnior
- Division of Medical Imaging, Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto School of Medicine, São Paulo University, Ribeirão Preto, SP, Brazil
| | - Carlos Henrique Miranda
- Division of Emergency Medicine, Department of Internal Medicine, Ribeirão Preto School of Medicine, São Paulo University, Ribeirão Preto, SP, Brazil.
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179
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Neurological Sequelae in Patients with COVID-19: A Histopathological Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021. [PMID: 33546463 DOI: 10.3390/ijerph18041415.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Neuroinvasive properties of SARS-CoV-2 have allowed the hypothesis of several pathogenic mechanisms related to acute and chronic neurological sequelae. However, neuropathological correlates have been poorly systematically investigated, being retrieved from reports of single case or limited case series still. METHODS A PubMed search was carried out to review all publications on autopsy in subjects with "COronaVIrus Disease-19" (COVID-19). Among them, we focused on histological findings of the brain, which were compared with those from the authors' autoptic studies performed in some COVID-19 patients. RESULTS Only seven studies reported histological evidence of brain pathology in patients deceased for COVID-19, including three with reverse transcription-quantitative polymerase chain reaction evidence of viral infection. All these studies, in line with our experience, showed vascular-related and infection-related secondary inflammatory tissue damage due to an abnormal immune response. It is still unclear, however, whether these findings are the effect of a direct viral pathology or rather reflect a non-specific consequence of cardiovascular and pulmonary disease on the brain. CONCLUSIONS Notwithstanding the limited evidence available and the heterogeneity of the studies, we provide a preliminary description of the relationship between SARS-CoV-2 and brain sequelae. Systematic autoptic investigations are needed for accurate detection and adequate management of these patients.
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Fisicaro F, Di Napoli M, Liberto A, Fanella M, Di Stasio F, Pennisi M, Bella R, Lanza G, Mansueto G. Neurological Sequelae in Patients with COVID-19: A Histopathological Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041415. [PMID: 33546463 PMCID: PMC7913756 DOI: 10.3390/ijerph18041415] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/18/2021] [Accepted: 01/29/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Neuroinvasive properties of SARS-CoV-2 have allowed the hypothesis of several pathogenic mechanisms related to acute and chronic neurological sequelae. However, neuropathological correlates have been poorly systematically investigated, being retrieved from reports of single case or limited case series still. METHODS A PubMed search was carried out to review all publications on autopsy in subjects with "COronaVIrus Disease-19" (COVID-19). Among them, we focused on histological findings of the brain, which were compared with those from the authors' autoptic studies performed in some COVID-19 patients. RESULTS Only seven studies reported histological evidence of brain pathology in patients deceased for COVID-19, including three with reverse transcription-quantitative polymerase chain reaction evidence of viral infection. All these studies, in line with our experience, showed vascular-related and infection-related secondary inflammatory tissue damage due to an abnormal immune response. It is still unclear, however, whether these findings are the effect of a direct viral pathology or rather reflect a non-specific consequence of cardiovascular and pulmonary disease on the brain. CONCLUSIONS Notwithstanding the limited evidence available and the heterogeneity of the studies, we provide a preliminary description of the relationship between SARS-CoV-2 and brain sequelae. Systematic autoptic investigations are needed for accurate detection and adequate management of these patients.
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Affiliation(s)
- Francesco Fisicaro
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy; (F.F.); (A.L.); (M.P.)
| | - Mario Di Napoli
- Department of Neurology and Stroke Unit, San Camillo de’ Lellis General Hospital, Viale Kennedy 1, 02100 Rieti, Italy; (M.D.N.); (M.F.)
| | - Aldo Liberto
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy; (F.F.); (A.L.); (M.P.)
| | - Martina Fanella
- Department of Neurology and Stroke Unit, San Camillo de’ Lellis General Hospital, Viale Kennedy 1, 02100 Rieti, Italy; (M.D.N.); (M.F.)
| | - Flavio Di Stasio
- Department of Neurology and Stroke Unit Cesena-Forlì, Bufalini Hospital, AUSL Romagna, Viale Ghirotti 286, 47521 Cesena, Italy;
| | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy; (F.F.); (A.L.); (M.P.)
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Via Santa Sofia 87, 95123 Catania, Italy;
| | - Giuseppe Lanza
- Department of Surgery and Medical-Surgery Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
- Department of Neurology IC, Oasi Research Institute-IRCCS, Via Conte Ruggero 78, 94018 Troina, Italy
- Correspondence: ; Tel.: +39-095-3782448
| | - Gelsomina Mansueto
- Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy;
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Tsutsumi T, Saito M, Nagai H, Yamamoto S, Ikeuchi K, Lim LA, Adachi E, Koga M, Okushin K, Akai H, Kunimatsu A, Yotsuyanagi H. Association of coagulopathy with liver dysfunction in patients with COVID-19. Hepatol Res 2021; 51:227-232. [PMID: 33047431 PMCID: PMC7675264 DOI: 10.1111/hepr.13577] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 02/06/2023]
Abstract
AIM Liver dysfunction is sometimes observed in patients with coronavirus disease 2019 (COVID-19), but most studies are from China, and the frequency in other countries is unclear. In addition, previous studies suggested several mechanisms of liver damage, but precise or additional mechanisms are not clearly elucidated. Therefore, we examined COVID-19 patients to explore the proportion of patients with liver dysfunction and also the factors associated with liver dysfunction. METHODS We retrospectively examined 60 COVID-19 patients hospitalized at the Hospital affiliated with The Institute of Medical Science, The University of Tokyo (Tokyo, Japan). Patients who presented ≥40 U/L alanine aminotransferase (ALT) levels at least once during their hospitalization were defined as high-ALT patients, and the others as normal-ALT patients. The worst values of physical and laboratory findings during hospitalization for each patient were extracted for the analyses. Univariable and multivariable logistic regression models with bootstrap (for 1000 times) were carried out. RESULTS Among 60 patients, there were 31 (52%) high-ALT patients. The high-ALT patients were obese, and had significantly higher levels of D-dimer and fibrin/fibrinogen degradation products, as well as white blood cell count, and levels of C-reactive protein, ferritin, and fibrinogen. Multivariable analysis showed D-dimer and white blood cells as independent factors. CONCLUSIONS Considering that higher D-dimer level and white blood cell count were independently associated with ALT elevation, liver dysfunction in COVID-19 patients might be induced by microvascular thrombosis in addition to systemic inflammation.
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Affiliation(s)
- Takeya Tsutsumi
- Division of Infectious Diseases, Advanced Clinical Research Center, The Institute of Medical ScienceThe University of TokyoTokyoJapan
| | - Makoto Saito
- Division of Infectious Diseases, Advanced Clinical Research Center, The Institute of Medical ScienceThe University of TokyoTokyoJapan
| | - Hiroyuki Nagai
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital, The Institute of Medical ScienceThe University of TokyoTokyoJapan
| | - Shinya Yamamoto
- Division of Infectious Diseases, Advanced Clinical Research Center, The Institute of Medical ScienceThe University of TokyoTokyoJapan
| | - Kazuhiko Ikeuchi
- Division of Infectious Diseases, Advanced Clinical Research Center, The Institute of Medical ScienceThe University of TokyoTokyoJapan
| | - Lay Ahyoung Lim
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital, The Institute of Medical ScienceThe University of TokyoTokyoJapan
| | - Eisuke Adachi
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital, The Institute of Medical ScienceThe University of TokyoTokyoJapan
| | - Michiko Koga
- Division of Infectious Diseases, Advanced Clinical Research Center, The Institute of Medical ScienceThe University of TokyoTokyoJapan
| | - Kazuya Okushin
- Department of Infection Control and Prevention, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Hiroyuki Akai
- Department of Radiology, The Institute of Medical ScienceThe University of TokyoTokyoJapan
| | - Akira Kunimatsu
- Department of Radiology, The Institute of Medical ScienceThe University of TokyoTokyoJapan
| | - Hiroshi Yotsuyanagi
- Division of Infectious Diseases, Advanced Clinical Research Center, The Institute of Medical ScienceThe University of TokyoTokyoJapan,Department of Infectious Diseases and Applied Immunology, IMSUT Hospital, The Institute of Medical ScienceThe University of TokyoTokyoJapan
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182
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Giorgetti A, Orazietti V, Busardò FP, Pirani F, Giorgetti R. Died with or Died of? Development and Testing of a SARS CoV-2 Significance Score to Assess the Role of COVID-19 in the Deaths of Affected Patients. Diagnostics (Basel) 2021; 11:190. [PMID: 33525705 PMCID: PMC7912253 DOI: 10.3390/diagnostics11020190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/18/2021] [Accepted: 01/26/2021] [Indexed: 12/24/2022] Open
Abstract
Since December 2019, a new form of coronavirus, SARS-CoV-2, has spread from China to the whole word, raising concerns regarding Coronavirus Disease 2019 (COVID-19) endangering public health and life. Over 1.5 million deaths related with COVID-19 have been recorded worldwide, with wide variations among countries affected by the pandemic and continuously growing numbers. The aim of this paper was to provide an overview of the literature cases of deaths involving COVID-19 and to evaluate the application of the COVID-19 Significance Score (CSS) in the classification of SARS CoV-2-related fatalities, comparing it with the Hamburg rating scale. The results obtained allowed us to highlight that CSS used after a complete accurate post-mortem examination, coupled to the retrieval of in vivo data, post-mortem radiology, histology and toxicology, as well as to additional required analyses (e.g., electronic microscopy) is a useful and concise tool in the assessment of the cause of death and the role played by this virus. A shared use of this scale might hopefully lower the inhomogeneities in forensic evaluation of SARS CoV-2-related fatalities.
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Affiliation(s)
- Arianna Giorgetti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy;
| | - Vasco Orazietti
- Department of Excellence of Biomedical Sciences and Public Health, University “Politecnica delle Marche” of Ancona, Via Conca 71, 60126 Ancona, Italy; (V.O.); (F.P.B.); (R.G.)
| | - Francesco Paolo Busardò
- Department of Excellence of Biomedical Sciences and Public Health, University “Politecnica delle Marche” of Ancona, Via Conca 71, 60126 Ancona, Italy; (V.O.); (F.P.B.); (R.G.)
| | - Filippo Pirani
- Department of Excellence of Biomedical Sciences and Public Health, University “Politecnica delle Marche” of Ancona, Via Conca 71, 60126 Ancona, Italy; (V.O.); (F.P.B.); (R.G.)
| | - Raffaele Giorgetti
- Department of Excellence of Biomedical Sciences and Public Health, University “Politecnica delle Marche” of Ancona, Via Conca 71, 60126 Ancona, Italy; (V.O.); (F.P.B.); (R.G.)
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183
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Ugolotti MC, Pedrazzini M, Silini EM, Missale G, Silva M, Franzini C, Palmieri G, Costi R, Montali F, Gnappi E, Terroni L, Colizzi E, Meschi M, Facchinetti F. Vascular liver injury mimicking an intrahepatic cholangiocarcinoma in a COVID-19 patient. J Med Virol 2021; 93:1940-1942. [PMID: 33458846 PMCID: PMC8013583 DOI: 10.1002/jmv.26803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 12/12/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Maria C Ugolotti
- Internal Medicine, Fidenza Hospital, Local Health Authority, Parma, Italy
| | | | - Enrico M Silini
- Pathology Unit, University Hospital of Parma, Parma, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Gabriele Missale
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Unit of Infectious Diseases and Hepatology, University Hospital of Parma, Parma, Italy
| | - Mario Silva
- Section of "Scienze Radiologiche", Diagnostic Department, University Hospital of Parma, Parma, Italy
| | - Christian Franzini
- General Surgery Unit, Fidenza Hospital, Local Health Authority, Parma, Italy
| | - Gerardo Palmieri
- General Surgery Unit, Fidenza Hospital, Local Health Authority, Parma, Italy
| | - Renato Costi
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,General Surgery Unit, Fidenza Hospital, Local Health Authority, Parma, Italy
| | - Filippo Montali
- General Surgery Unit, Fidenza Hospital, Local Health Authority, Parma, Italy
| | - Elisa Gnappi
- Internal Medicine, Fidenza Hospital, Local Health Authority, Parma, Italy
| | - Lorenza Terroni
- Internal Medicine, Fidenza Hospital, Local Health Authority, Parma, Italy
| | - Elena Colizzi
- Internal Medicine, Fidenza Hospital, Local Health Authority, Parma, Italy
| | - Michele Meschi
- Internal Medicine, Fidenza Hospital, Local Health Authority, Parma, Italy
| | - Francesco Facchinetti
- Internal Medicine, Fidenza Hospital, Local Health Authority, Parma, Italy.,Institut Gustave Roussy, Université Paris-Saclay, Inserm, Biomarqueurs Prédictifs et Nouvelles Stratégies Thérapeutiques en Oncologie, Villejuif, France
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184
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Busana M, Giosa L, Cressoni M, Gasperetti A, Di Girolamo L, Martinelli A, Sonzogni A, Lorini L, Palumbo MM, Romitti F, Gattarello S, Steinberg I, Herrmann P, Meissner K, Quintel M, Gattinoni L. The impact of ventilation-perfusion inequality in COVID-19: a computational model. J Appl Physiol (1985) 2021; 130:865-876. [PMID: 33439790 PMCID: PMC8083177 DOI: 10.1152/japplphysiol.00871.2020] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
COVID-19 infection may lead to acute respiratory distress syndrome (CARDS) where severe gas exchange derangements may be associated, at least in the early stages, only with minor pulmonary infiltrates. This may suggest that the shunt associated to the gasless lung parenchyma is not sufficient to explain CARDS hypoxemia. We designed an algorithm (VentriQlar), based on the same conceptual grounds described by J.B. West in 1969. We set 498 ventilation-perfusion (VA/Q) compartments and, after calculating their blood composition (PO2, PCO2, and pH), we randomly chose 106 combinations of five parameters controlling a bimodal distribution of blood flow. The solutions were accepted if the predicted PaO2 and PaCO2 were within 10% of the patient's values. We assumed that the shunt fraction equaled the fraction of non-aerated lung tissue at the CT quantitative analysis. Five critically-ill patients later deceased were studied. The PaO2/FiO2 was 91.1 ± 18.6 mmHg and PaCO2 69.0 ± 16.1 mmHg. Cardiac output was 9.58 ± 0.99 L/min. The fraction of non-aerated tissue was 0.33 ± 0.06. The model showed that a large fraction of the blood flow was likely distributed in regions with very low VA/Q (Qmean = 0.06 ± 0.02) and a smaller fraction in regions with moderately high VA/Q. Overall LogSD, Q was 1.66 ± 0.14, suggestive of high VA/Q inequality. Our data suggest that shunt alone cannot completely account for the observed hypoxemia and a significant VA/Q inequality must be present in COVID-19. The high cardiac output and the extensive microthrombosis later found in the autopsy further support the hypothesis of a pathological perfusion of non/poorly ventilated lung tissue.NEW & NOTEWORTHY Hypothesizing that the non-aerated lung fraction as evaluated by the quantitative analysis of the lung computed tomography (CT) equals shunt (VA/Q = 0), we used a computational approach to estimate the magnitude of the ventilation-perfusion inequality in severe COVID-19. The results show that a severe hyperperfusion of poorly ventilated lung region is likely the cause of the observed hypoxemia. The extensive microthrombosis or abnormal vasodilation of the pulmonary circulation may represent the pathophysiological mechanism of such VA/Q distribution.
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Affiliation(s)
- Mattia Busana
- Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center of Göttingen, Göttingen, Germany
| | - Lorenzo Giosa
- Department of Surgical Science, University of Turin, Italy
| | - Massimo Cressoni
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato, Italy
| | - Alessio Gasperetti
- Department of Cardiology, IRCCS Cardiologico Monzino, San Donato Milanese, Italy
| | - Luca Di Girolamo
- Department of Intensive Care Medicine, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Aurelio Sonzogni
- ASST Papa Giovanni XXIII, Department of Pathology, Bergamo, Italy
| | - Luca Lorini
- ASST Papa Giovanni XXIII, Department of Intensive Care Medicine, Bergamo, Italy
| | - Maria Michela Palumbo
- Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center of Göttingen, Göttingen, Germany
| | - Federica Romitti
- Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center of Göttingen, Göttingen, Germany
| | - Simone Gattarello
- Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center of Göttingen, Göttingen, Germany
| | - Irene Steinberg
- Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center of Göttingen, Göttingen, Germany
| | - Peter Herrmann
- Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center of Göttingen, Göttingen, Germany
| | - Konrad Meissner
- Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center of Göttingen, Göttingen, Germany
| | - Michael Quintel
- Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center of Göttingen, Göttingen, Germany
| | - Luciano Gattinoni
- Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center of Göttingen, Göttingen, Germany
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185
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Macor P, Durigutto P, Mangogna A, Bussani R, D'Errico S, Zanon M, Pozzi N, Meroni P, Tedesco F. Multi-organ complement deposition in COVID-19 patients. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.01.07.21249116. [PMID: 33442701 PMCID: PMC7805461 DOI: 10.1101/2021.01.07.21249116] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
BACKGROUND Increased levels of circulating complement activation products have been reported in COVID-19 patients, but only limited information is available on complement involvement at tissue level. The mechanisms and pathways of local complement activation remain unclear. METHODS We performed immunofluorescence analyses of autopsy specimens of lungs, kidney and liver from nine COVID-19 patients who died of acute respiratory failure. Snap-frozen samples embedded in OCT were stained with antibodies against complement components and activation products, IgG and spike protein of SARS-CoV-2. FINDINGS Lung deposits of C1q, C4, C3 and C5b-9 were localized in the capillaries of the interalveolar septa and on alveolar cells. IgG displayed a similar even distribution, suggesting classical pathway activation. The spike protein is a potential target of IgG, but its uneven distribution suggests that other viral and tissue molecules may be targeted by IgG. Factor B deposits were also seen in COVID-19 lungs and are consistent with activation of the alternative pathway, whereas MBL and MASP-2 were hardly detectable. Analysis of kidney and liver specimens mirrored findings observed in the lung. Complement deposits were seen on tubules and vessels of the kidney with only mild C5b-9 staining in glomeruli, and on hepatic artery and portal vein of the liver. INTERPRETATION Complement deposits in different organs of deceased COVID-19 patients caused by activation of the classical and alternative pathways support the multi-organ nature of the disease. FUNDING Grants from the Italian Ministry of Health (COVID-2020-12371808) to PLM and National Institutes of Health HL150146 to NP are gratefully acknowledged.
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186
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Nardo AD, Schneeweiss‐Gleixner M, Bakail M, Dixon ED, Lax SF, Trauner M. Pathophysiological mechanisms of liver injury in COVID-19. Liver Int 2021; 41:20-32. [PMID: 33190346 PMCID: PMC7753756 DOI: 10.1111/liv.14730] [Citation(s) in RCA: 224] [Impact Index Per Article: 74.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 02/06/2023]
Abstract
The recent outbreak of coronavirus disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has resulted in a world-wide pandemic. Disseminated lung injury with the development of acute respiratory distress syndrome (ARDS) is the main cause of mortality in COVID-19. Although liver failure does not seem to occur in the absence of pre-existing liver disease, hepatic involvement in COVID-19 may correlate with overall disease severity and serve as a prognostic factor for the development of ARDS. The spectrum of liver injury in COVID-19 may range from direct infection by SARS-CoV-2, indirect involvement by systemic inflammation, hypoxic changes, iatrogenic causes such as drugs and ventilation to exacerbation of underlying liver disease. This concise review discusses the potential pathophysiological mechanisms for SARS-CoV-2 hepatic tropism as well as acute and possibly long-term liver injury in COVID-19.
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Affiliation(s)
- Alexander D. Nardo
- Hans Popper Laboratory of Molecular HepatologyDivision of Gastroenterology and HepatologyDepartment of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Mathias Schneeweiss‐Gleixner
- Medical Intensive Care Unit 13H1. Division of Gastroenterology and HepatologyDepartment of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - May Bakail
- Campus ITInstitute of Science and Technology AustriaKlosterneuburgAustria
| | - Emmanuel D. Dixon
- Hans Popper Laboratory of Molecular HepatologyDivision of Gastroenterology and HepatologyDepartment of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Sigurd F. Lax
- Department of PathologyHospital Graz IIAcademic Teaching Hospital of the Medical University of GrazGrazAustria,School of MedicineJohannes Kepler UniversityLinzAustria
| | - Michael Trauner
- Hans Popper Laboratory of Molecular HepatologyDivision of Gastroenterology and HepatologyDepartment of Internal Medicine IIIMedical University of ViennaViennaAustria,Medical Intensive Care Unit 13H1. Division of Gastroenterology and HepatologyDepartment of Internal Medicine IIIMedical University of ViennaViennaAustria
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187
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Sweed D, El Shanshory MR, Elaskary EM, Hassan HA, Sweed E, Sweed E, Abdelsattar S, Abdelgawad A, Mosbeh A, Abdallah H, El-Mashad S, Ehsan N. Trichrome-positive intrahepatic cytoplasmic globules are potential histopathological clue for COVID-19-induced hepatitis: a case report. EGYPTIAN LIVER JOURNAL 2021; 11:69. [PMID: 34777872 PMCID: PMC8381346 DOI: 10.1186/s43066-021-00140-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/16/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection mainly affects respiratory system. Later, liver affection has also been reported in the form of marked elevated liver enzymes. However, the association of coronavirus disease-19 (COVID-19) and autoimmune diseases is not clear. CASE PRESENTATION A female patient with a known history of autoimmune hemolytic anemia (AIHH) for which she was treated with prednisolone was admitted for uncontrolled anemia followed by fever and elevated liver enzymes. All the laboratory and radiological investigations were not typical for COVID-19 or any other etiology. Liver biopsy revealed numerous pale eosinophilic trichrome-positive intracytoplasmic globules. The pathology raised the suspicion for SARS-CoV-2-associated hepatitis, which was confirmed by a positive IgG titer. The patient showed a dramatic improvement on the maintenance dose of prednisolone. CONCLUSIONS AIHA patients co-infected with SARS-CoV-2 may be at risk of uncontrolled disease and should continue their treatment regimen. Histopathology has a role in the diagnosis of liver affection due to SARS-CoV-2 infection.
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Affiliation(s)
- Dina Sweed
- grid.411775.10000 0004 0621 4712Pathology Department, National Liver Institute, Menoufia University, Shibin el Kom, Egypt
| | | | - Eman Mohammed Elaskary
- grid.412258.80000 0000 9477 7793Pediatric Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Hassnaa Atef Hassan
- grid.412258.80000 0000 9477 7793Pediatric Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Enas Sweed
- grid.411660.40000 0004 0621 2741Radiology Department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Eman Sweed
- grid.411775.10000 0004 0621 4712Clinical Pharmacology Department, Faculty of Medicine, Menoufia University, Shibin el Kom, Egypt
| | - Shimaa Abdelsattar
- grid.411775.10000 0004 0621 4712Clinical Pathology Department, National Liver Institute, Shibin el Kom, Egypt
| | - Ahmed Abdelgawad
- grid.411775.10000 0004 0621 4712Clinical Biochemistry, and Molecular Diagnostics Department, National Liver Institute, Menoufia University, Shibin el Kom, Egypt
| | - Asmaa Mosbeh
- grid.411775.10000 0004 0621 4712Pathology Department, National Liver Institute, Menoufia University, Shibin el Kom, Egypt
| | - Heba Abdallah
- grid.411775.10000 0004 0621 4712Clinical Biochemistry, and Molecular Diagnostics Department, National Liver Institute, Menoufia University, Shibin el Kom, Egypt
| | - Shereen El-Mashad
- grid.411775.10000 0004 0621 4712Pathology Department, National Liver Institute, Menoufia University, Shibin el Kom, Egypt
| | - Nermine Ehsan
- grid.411775.10000 0004 0621 4712Pathology Department, National Liver Institute, Menoufia University, Shibin el Kom, Egypt
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188
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Di Giorgio A, Hartleif S, Warner S, Kelly D. COVID-19 in Children With Liver Disease. Front Pediatr 2021; 9:616381. [PMID: 33777864 PMCID: PMC7991080 DOI: 10.3389/fped.2021.616381] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/19/2021] [Indexed: 12/15/2022] Open
Abstract
Background: The global pandemic caused by novel Coronavirus SARS-CoV-2 disease (COVID-19) is a major threat to the general population and for patients with pre-existing chronic conditions. We report data concerning SARS-CoV-2 infection in children with chronic liver disease (CLD). Methods: A literature review using the online database PubMed was performed to summarize available findings on the association between pre-existing liver disease and COVID-19 infection in children. Results: Children with COVID-19 have preserved effector and immunosuppressive components resulting in a milder disease compared to adults. The most common hepatic manifestation is an elevation of hepatic transaminases. Liver damage may be directly caused by viral infection of liver cells, by medications or by the chronic hypoxia seen in COVID-19 patients. A multicenter study reported that the majority of children with a CLD remained healthy during the outbreak. Similarly, studies reported that children on immunosuppressive treatment, including patients with autoimmune liver disease (AILD) and liver transplantation (LT), maintained good health during the outbreak without experiencing major complications even if infected with COVID-19. Conclusion: COVID-19-related liver injury presents with a mild elevation of transaminases, although its clinical significance is unclear. Children with CLD, including those with AILD and post-LT, do not have an increased risk for severe disease course of SARS-CoV-2 infection with little or no liver dysfunction. These data highlight the necessity to ensure normal standards of care while adhering to national Covid-19 guidelines, and particularly to maintain immunosuppressive medication to prevent relapse or rejection. Further research is required to evaluate the differences in clinical course between immunosuppressed adults and children and in particular whether asymptomatic infection is a concern.
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Affiliation(s)
- Angelo Di Giorgio
- Paediatric Liver, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Steffen Hartleif
- Paediatric Gastroenterology and Hepatology, University Children's Hospital, University of Tübingen, Tübingen, Germany
| | - Suzan Warner
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom.,The Liver Unit, Birmingham Women's and Children's Hospital, University of Birmingham, Birmingham, United Kingdom
| | - Deirdre Kelly
- The Liver Unit, Birmingham Women's and Children's Hospital, University of Birmingham, Birmingham, United Kingdom
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189
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Díaz LA, Idalsoaga F, Cannistra M, Candia R, Cabrera D, Barrera F, Soza A, Graham R, Riquelme A, Arrese M, Leise MD, Arab JP. High prevalence of hepatic steatosis and vascular thrombosis in COVID-19: A systematic review and meta-analysis of autopsy data. World J Gastroenterol 2020; 26:7693-7706. [PMID: 33505145 PMCID: PMC7789052 DOI: 10.3748/wjg.v26.i48.7693] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/26/2020] [Accepted: 12/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) disease can frequently affect the liver. Data on hepatic histopathological findings in COVID-19 is scarce.
AIM To characterize hepatic pathological findings in patients with COVID-19.
METHODS We conducted a systematic review with meta-analysis registered on PROSPERO (CRD42020192813), following PRISMA guidelines. Eligible trials were those including patients of any age and COVID-19 diagnosis based on a molecular test. Histopathological reports from deceased COVID-19 patients undergoing autopsy or liver biopsy were reviewed. Articles including less than ten patients were excluded. Proportions were pooled using random-effects models. Q statistic and I2 were used to assess heterogeneity and levels of evidence, respectively.
RESULTS We identified 18 studies from 7 countries; all were case reports and case series from autopsies. All the patients were over 15 years old, and 67.2% were male. We performed a meta-analysis of 5 studies, including 116 patients. Pooled prevalence estimates of liver histopathological findings were hepatic steatosis 55.1% [95% confidence interval (CI): 46.2-63.8], congestion of hepatic sinuses 34.7% (95%CI: 7.9-68.4), vascular thrombosis 29.4% (95%CI: 0.4-87.2), fibrosis 20.5% (95%CI: 0.6-57.9), Kupffer cell hyperplasia 13.5% (95%CI: 0.6-54.3), portal inflammation 13.2% (95%CI: 0.1-48.8), and lobular inflammation 11.6% (95%CI: 0.3-35.7). We also identified the presence of venous outflow obstruction, phlebosclerosis of the portal vein, herniated portal vein, periportal abnormal vessels, hemophagocytosis, and necrosis.
CONCLUSION We found a high prevalence of hepatic steatosis and vascular thrombosis as major histological liver features. Other frequent findings included portal and lobular inflammation and Kupffer cell hyperplasia or proliferation. Further studies are needed to establish the mechanisms and implications of these findings.
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Affiliation(s)
- Luis Antonio Díaz
- 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
| | - Roberto Candia
- Department of Gastroenterology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago 8320000, Chile
| | - Daniel Cabrera
- Facultad de Ciencias Médicas, Universidad Bernardo O'Higgins, Santiago 8320000, Chile
| | - Francisco Barrera
- Department of Gastroenterology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago 8320000, Chile
| | - Alejandro Soza
- Department of Gastroenterology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago 8320000, Chile
| | - Rondell Graham
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Minnesota, MN 55902, United States
| | - Arnoldo Riquelme
- Department of Gastroenterology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago 8320000, Chile
| | - 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
| | - Juan Pablo Arab
- Department of Gastroenterology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago 8320000, Chile
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190
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Mageriu V, Zurac S, Bastian A, Staniceanu F, Manole E. Histological findings in skeletal muscle of SARS-CoV2 infected patient. J Immunoassay Immunochem 2020; 41:1000-1009. [PMID: 33353460 DOI: 10.1080/15321819.2020.1863819] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Autopsies represent medical procedures through which the causes of patients' deaths are determined or, through tissue sampling and microscopic examination of slides in usual stains or special tests, one can offer the basis for understanding the physiopathological mechanisms that contribute to the patients' death Histological findings of tissue samples from patients who have died of COVID-19 have been mainly orientated to lung, heart, liver, kidney damage with a small percent of them following other organs, but none has, to our knowledge, studied skeletal muscle.
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Affiliation(s)
- Vlad Mageriu
- Pathology, University Emergency Hospital Elias , Bucharest, Romania
| | - Sabina Zurac
- Pathology, Colentina University Hospital , Bucharest, Romania
| | - Alexandra Bastian
- Pathology, Colentina University Hospital , Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy , Bucharest, Romania
| | - Florica Staniceanu
- "Carol Davila" University of Medicine and Pharmacy , Bucharest, Romania.,Pathology, Colentina Clinical Hospital , Bucharest, Romania
| | - Emilia Manole
- Molecular Biology, "Victor Babes" National Institute of Pathology , Bucharest, Romania
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191
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Hanafy AS, Abd-Elsalam S. Challenges in COVID-19 drug treatment in patients with advanced liver diseases: A hepatology perspective. World J Gastroenterol 2020; 26:7272-7286. [PMID: 33362383 PMCID: PMC7739155 DOI: 10.3748/wjg.v26.i46.7272] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/06/2020] [Accepted: 11/21/2020] [Indexed: 02/06/2023] Open
Abstract
The global incidence of coronavirus disease 2019 (COVID-19) continues to increase despite health care efforts. The disease is caused by coronavirus 2 with high transmission and mortality rates. Little is known about the management of COVID-19 in advanced liver disease. The aim of work was to propose a plan for management of this drastic disease in case of this specific population with review of medications that could be suitable for advanced liver disease. All the guidelines and medications available for treatment of COVID-19 were reviewed with selection of the less toxic medications that could be used in advanced liver disease. Drugs suitable to manage COVID-19 in patients with liver disease might include remdesivir intravenously, nitazoxanide + sofosbuvir, ivermectin, tocilizumab, convalescent plasma, and low molecular weight heparin in certain situations. Advanced liver disease is associated with portal hypertension and splenomegaly with reduction of blood elements and immune dysfunction and impaired T cell function. Thus, when confronted by cytokine storm as an immune response to COVID-19, there may be an increase in the mortality rate of these patients. Through this review, a plan to treat COVID-19 in this special group of patients with advanced cirrhosis is proposed.
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192
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Nardo AD, Schneeweiss-Gleixner M, Bakail M, Dixon ED, Lax SF, Trauner M. Pathophysiological mechanisms of liver injury in COVID-19. LIVER INTERNATIONAL : OFFICIAL JOURNAL OF THE INTERNATIONAL ASSOCIATION FOR THE STUDY OF THE LIVER 2020. [PMID: 33190346 DOI: 10.1111/liv.14730.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The recent outbreak of coronavirus disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has resulted in a world-wide pandemic. Disseminated lung injury with the development of acute respiratory distress syndrome (ARDS) is the main cause of mortality in COVID-19. Although liver failure does not seem to occur in the absence of pre-existing liver disease, hepatic involvement in COVID-19 may correlate with overall disease severity and serve as a prognostic factor for the development of ARDS. The spectrum of liver injury in COVID-19 may range from direct infection by SARS-CoV-2, indirect involvement by systemic inflammation, hypoxic changes, iatrogenic causes such as drugs and ventilation to exacerbation of underlying liver disease. This concise review discusses the potential pathophysiological mechanisms for SARS-CoV-2 hepatic tropism as well as acute and possibly long-term liver injury in COVID-19.
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Affiliation(s)
- Alexander D Nardo
- Hans Popper Laboratory of Molecular Hepatology, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Mathias Schneeweiss-Gleixner
- Medical Intensive Care Unit 13H1. Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - May Bakail
- Campus IT, Institute of Science and Technology Austria, Klosterneuburg, Austria
| | - Emmanuel D Dixon
- Hans Popper Laboratory of Molecular Hepatology, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Sigurd F Lax
- Department of Pathology, Hospital Graz II, Academic Teaching Hospital of the Medical University of Graz, Graz, Austria.,School of Medicine, Johannes Kepler University, Linz, Austria
| | - Michael Trauner
- Hans Popper Laboratory of Molecular Hepatology, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Medical Intensive Care Unit 13H1. Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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193
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Váncsa S, Hegyi PJ, Zádori N, Szakó L, Vörhendi N, Ocskay K, Földi M, Dembrovszky F, Dömötör ZR, Jánosi K, Rakonczay Z, Hartmann P, Horváth T, Erőss B, Kiss S, Szakács Z, Németh D, Hegyi P, Pár G. Pre-existing Liver Diseases and On-Admission Liver-Related Laboratory Tests in COVID-19: A Prognostic Accuracy Meta-Analysis With Systematic Review. Front Med (Lausanne) 2020; 7:572115. [PMID: 33282888 PMCID: PMC7691431 DOI: 10.3389/fmed.2020.572115] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/05/2020] [Indexed: 01/08/2023] Open
Abstract
Background: We aimed to perform a systematic search and meta-analysis to evaluate the prognostic value of on-admission liver function tests and pre-existing liver diseases on the clinical course of coronavirus disease 2019 (COVID-19). Methods: The study was registered on PROSPERO (CRD42020182902). We searched five databases between 01/01/2020 and 04/23/2020. Studies that reported on liver-related comorbidities and/or laboratory parameters in patients with COVID-19 were included. The main outcomes were COVID-19 severity, intensive care unit (ICU) admission, and in-hospital mortality. Analysis of predictive models hierarchical summary receiver-operating characteristic (HSROC) was conducted with a 95% confidence interval (CI). Results: Fifty studies were included in the meta-analysis. High specificity was reached by acute liver failure associated by COVID-19 (0.94, 95% CI: 0.71–0.99) and platelet count (0.94, 95% CI: 0.71–0.99) in the case of mortality; chronic liver disease (CLD) (0.98, 95% CI: 0.96–0.99) and platelet count (0.82, 95% CI: 0.72–0.89) in the case of ICU requirement; and CLD (0.97, 95% CI: 0.95–0.98), chronic hepatitis B infection (0.97, 95% CI: 0.95–0.98), platelet count (0.86, 95% CI: 0.77–0.91), and alanine aminotransferase (ALT) (0.80, 95% CI: 0.66–0.89) and aspartate aminotransferase (AST) (0.84, 95% CI: 0.77–0.88) activities considering severe COVID-19. High sensitivity was found in the case of C-reactive protein (CRP) for ICU requirement (0.92, 95% CI: 0.80–0.97) and severe COVID-19 (0.91, 95% CI: 0.82–0.96). Conclusion: On-admission platelet count, ALT and AST activities, CRP concentration, and the presence of acute and CLDs predicted the severe course of COVID-19. To highlight, pre-existing liver diseases or acute liver injury associated by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection plays an important role in the prediction of mortality.
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Affiliation(s)
- Szilárd Váncsa
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,János Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Péter Jeno Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Noémi Zádori
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,János Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Lajos Szakó
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,János Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Nóra Vörhendi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,János Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Klementina Ocskay
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,János Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Mária Földi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,János Szentágothai Research Center, University of Pécs, Pécs, Hungary.,Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Fanni Dembrovszky
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,János Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Zsuzsa Réka Dömötör
- Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureş, Târgu Mureş, Romania
| | - Kristóf Jánosi
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
| | - Zoltán Rakonczay
- Department of Pathophysiology, University of Szeged, Szeged, Hungary
| | - Petra Hartmann
- Institute of Surgical Research, University of Szeged, Szeged, Hungary
| | - Tamara Horváth
- Institute of Surgical Research, University of Szeged, Szeged, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Szabolcs Kiss
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,János Szentágothai Research Center, University of Pécs, Pécs, Hungary.,Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Zsolt Szakács
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,János Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Dávid Németh
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,János Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Gabriella Pár
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
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194
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Hepatic pathology in patients dying of COVID-19: a series of 40 cases including clinical, histologic, and virologic data. Mod Pathol 2020; 33:2147-2155. [PMID: 32792598 PMCID: PMC7424245 DOI: 10.1038/s41379-020-00649-x] [Citation(s) in RCA: 166] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 02/06/2023]
Abstract
The novel coronavirus SARS-CoV-2 (coronavirus disease 19, or COVID-19) primarily causes pulmonary injury, but has been implicated to cause hepatic injury, both by serum markers and histologic evaluation. The histologic pattern of injury has not been completely described. Studies quantifying viral load in the liver are lacking. Here we report the clinical and histologic findings related to the liver in 40 patients who died of complications of COVID-19. A subset of liver tissue blocks were subjected to polymerase chain reaction (PCR) for viral ribonucleic acid (RNA). Peak levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were elevated; median ALT peak 68 U/l (normal up to 46 U/l) and median AST peak 102 U/l (normal up to 37 U/l). Macrovesicular steatosis was the most common finding, involving 30 patients (75%). Mild lobular necroinflammation and portal inflammation were present in 20 cases each (50%). Vascular pathology, including sinusoidal microthrombi, was infrequent, seen in six cases (15%). PCR of liver tissue was positive in 11 of 20 patients tested (55%). In conclusion, we found patients dying of COVID-19 had biochemical evidence of hepatitis (of variable severity) and demonstrated histologic findings of macrovesicular steatosis and mild acute hepatitis (lobular necroinflammation) and mild portal inflammation. We also identified viral RNA in a sizeable subset of liver tissue samples.
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195
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Chen S, Liu H, Li T, Huang R, Gui R, Zhang J. Correlation analysis of coagulation dysfunction and liver damage in patients with novel coronavirus pneumonia: a single-center, retrospective, observational study. Ups J Med Sci 2020; 125:293-296. [PMID: 32990149 PMCID: PMC7594753 DOI: 10.1080/03009734.2020.1822960] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The novel coronavirus disease 2019 (COVID-19) is currently breaking out worldwide. COVID-19 patients may have different degrees of coagulopathy, but the mechanism is not yet clear. We aimed to analyse the relationship between coagulation dysfunction and liver damage in patients with COVID-19. METHODS A retrospective analysis of 74 patients with COVID-19 admitted to the First People's Hospital of Yueyang from 1 January to 30 March 2020 was carried out. According to the coagulation function, 27 cases entered the coagulopathy group and 47 cases entered the control group. A case control study was conducted to analyse the correlation between the occurrence of coagulation dysfunction and liver damage in COVID-19 patients. RESULTS Alanine aminotransferase (ALT) and aspartate aminotransferase (AST), markers of liver damage, were positively correlated with coagulopathy (p = 0.039, OR 2.960, 95% CI 1.055-8.304; and p = 0.028, OR 3.352, 95% CI 1.137-9.187). Alkaline phosphatase (ALP), γ-glutamyl transpeptidase (γ-GT), and total bilirubin (TBIL) were not statistically correlated with coagulopathy. According to the diagnosis and treatment plan, the included cases were classified into mild, moderate, severe, and critical. The results showed that the occurrence of coagulation dysfunction had no statistical correlation with the severity of COVID-19. CONCLUSION Coagulation dysfunction in patients with COVID-19 is closely related to liver damage. A longer course of the disease may cause a vicious circle of coagulopathy and liver damage. Clinicians need to closely monitor coagulation and liver function tests and to give prophylactic or supportive therapy when needed.
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Affiliation(s)
- Sai Chen
- Department of Blood Transfusion, the Third Xiangya Hospital of Central South University, Changsha, China
| | - Hanting Liu
- Department of Blood Transfusion, the Third Xiangya Hospital of Central South University, Changsha, China
| | - Tie Li
- Department of Clinical Laboratory, the First People’s Hospital of Yueyang, Yueyang, China
| | - Rong Huang
- Department of Blood Transfusion, the Third Xiangya Hospital of Central South University, Changsha, China
| | - Rong Gui
- Department of Blood Transfusion, the Third Xiangya Hospital of Central South University, Changsha, China
- CONTACT Rong Gui
| | - Junhua Zhang
- Department of Blood Transfusion, the Third Xiangya Hospital of Central South University, Changsha, China
- Junhua Zhang Department of Blood Transfusion, the Third Xiangya Hospital of Central South University, Changsha, China
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196
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Al-Sarraj S, Troakes C, Hanley B, Osborn M, Richardson MP, Hotopf M, Bullmore E, Everall IP. Invited Review: The spectrum of neuropathology in COVID-19. Neuropathol Appl Neurobiol 2020; 47:3-16. [PMID: 32935873 DOI: 10.1111/nan.12667] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 12/21/2022]
Abstract
There is increasing evidence that patients with Coronavirus disease 19 (COVID-19) present with neurological and psychiatric symptoms. Anosmia, hypogeusia, headache, nausea and altered consciousness are commonly described, although there are emerging clinical reports of more serious and specific conditions such as acute cerebrovascular accident, encephalitis and demyelinating disease. Whether these presentations are directly due to viral invasion of the central nervous system (CNS) or caused by indirect mechanisms has yet to be established. Neuropathological examination of brain tissue at autopsy will be essential to establish the neuro-invasive potential of the SARS-CoV-2 virus but, to date, there have been few detailed studies. The pathological changes in the brain probably represent a combination of direct cytopathic effects mediated by SARS-CoV-2 replication or indirect effects due to respiratory failure, injurious cytokine reaction, reduced immune response and cerebrovascular accidents induced by viral infection. Further large-scale molecular and cellular investigations are warranted to clarify the neuropathological correlates of the neurological and psychiatric features seen clinically in COVID-19. In this review, we summarize the current reports of neuropathological examination in COVID-19 patients, in addition to our own experience, and discuss their contribution to the understanding of CNS involvement in this disease.
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Affiliation(s)
- S Al-Sarraj
- Department of Clinical Neuropathology, King's College Hospital NHS Foundation Trust, London, UK.,London Neurodegenerative Diseases Brain Bank, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - C Troakes
- London Neurodegenerative Diseases Brain Bank, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - B Hanley
- Department of Cellular Pathology, Imperial College Healthcare NHS Trust, London, UK
| | - M Osborn
- Department of Cellular Pathology, Imperial College Healthcare NHS Trust, London, UK
| | - M P Richardson
- The Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - M Hotopf
- The Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,National Institute of Health Research Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
| | - E Bullmore
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - I P Everall
- The Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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197
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Busana M, Schiavone M, Lanfranchi A, Battista Forleo G, Ceriani E, Beatrice Cogliati C, Gasperetti A. Non-invasive hemodynamic profile of early COVID-19 infection. Physiol Rep 2020; 8:e14628. [PMID: 33113285 PMCID: PMC7592880 DOI: 10.14814/phy2.14628] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/04/2020] [Accepted: 10/05/2020] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Little is known about the systemic and pulmonary macrohemodynamics in early COVID-19 infection. Echocardiography may provide useful insights into COVID-19 physiopathology. METHODS Twenty-three COVID-19 patients were enrolled in a medical ward. Gas exchange, transthoracic echocardiographic, and hemodynamic variables were collected. RESULTS Mean age was 57 ± 17 years. The patients were hypoxemic (PaO2 /FiO2 = 273.0 ± 102.6 mmHg) and mildly hypocapnic (PaCO2 = 36.2 ± 6.3 mmHg, pH = 7.45 ± 0.03). Mean arterial pressure was decreased (86.7 [80.0-88.3] mmHg). Cardiac index was elevated (4.32 ± 0.90 L∙min-1 ∙m-2 ) and the resulting systemic vascular resistance index low (1,458 [1358-1664] dyn∙s∙cm-5 ∙m-2 ). The right heart was morphologically and functionally normal, with pulmonary artery pressure (PAPm, 18.0 ± 2.9 mmHg) and Total Pulmonary Resistances (TPR, 2.3 [2.1-2.7] mmHg∙l-1 ∙min-1 ) within normal limits. When stratifying for SVRI, patients with an SVRI value below the cohort median had also more severe oxygenation impairment and lower TPR, despite a similar degree of CXR infiltrates. Oxygen delivery index in this group resulted supranormal. CONCLUSIONS In the early stages of COVID-19 infection the hemodynamic profile is characterized by a hyperdynamic circulatory state with high CI and low SVRI, while the right heart is functionally unaffected. Our findings suggest that hypoxemia, viral sepsis or peripheral shunting are possible mechanisms for the vasodilation that dominates at this stage of the disease and may itself worsen the gas exchange.
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Affiliation(s)
- Mattia Busana
- Department of AnesthesiologyUniversity Medical Center GöttingenGöttingenGermany
| | - Marco Schiavone
- Department of CardiologyASST‐Fatebenefratelli SaccoLuigi Sacco HospitalUniversity of MilanMilanItaly
| | - Antonio Lanfranchi
- Department of CardiologyASST‐Fatebenefratelli SaccoLuigi Sacco HospitalUniversity of MilanMilanItaly
| | - Giovanni Battista Forleo
- Department of CardiologyASST‐Fatebenefratelli SaccoLuigi Sacco HospitalUniversity of MilanMilanItaly
| | - Elisa Ceriani
- Department of Internal MedicineASST‐Fatebenefratelli SaccoLuigi Sacco HospitalUniversity of MilanMilanItaly
| | - Chiara Beatrice Cogliati
- Department of Internal MedicineASST‐Fatebenefratelli SaccoLuigi Sacco HospitalUniversity of MilanMilanItaly
| | - Alessio Gasperetti
- Department of CardiologyASST‐Fatebenefratelli SaccoLuigi Sacco HospitalUniversity of MilanMilanItaly
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Boettler T, Marjot T, Newsome PN, Mondelli MU, Maticic M, Cordero E, Jalan R, Moreau R, Cornberg M, Berg T. Impact of COVID-19 on the care of patients with liver disease: EASL-ESCMID position paper after 6 months of the pandemic. JHEP Rep 2020; 2:100169. [PMID: 32835190 PMCID: PMC7402276 DOI: 10.1016/j.jhepr.2020.100169] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 02/06/2023] Open
Abstract
During the early stages of the coronavirus disease 2019 (COVID-19) pandemic, EASL and ESCMID published a position paper to provide guidance for physicians involved in the care of patients with chronic liver disease. While some healthcare systems are returning to a more normal routine, many countries and healthcare systems have been, or still are, overwhelmed by the pandemic, which is significantly impacting on the care of these patients. In addition, many studies have been published focusing on how COVID-19 may affect the liver and how pre-existing liver diseases might influence the clinical course of COVID-19. While many aspects remain poorly understood, it has become increasingly evident that pre-existing liver diseases and liver injury during the disease course must be kept in mind when caring for patients with COVID-19. This review should serve as an update on the previous position paper, summarising the evidence for liver disease involvement during COVID-19 and providing recommendations on how to return to routine care wherever possible.
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Key Words
- ACE2, angiotensin-converting enzyme 2
- ACLF, acute-on-chronic liver failure
- COVID-19
- COVID-19, coronavirus disease 2019
- Cancer
- Cirrhosis
- ERC, endoscopic retrograde cholangiography
- HCC, hepatocellular carcinoma
- IL-6, interleukin-6
- LT, liver transplant
- Liver
- MELD, model for end-stage liver disease
- NAFLD
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- OGD, oesophagogastroduodenoscopy
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- Telemedicine
- Transplantation
- ULN, upper limit of normal
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Affiliation(s)
- Tobias Boettler
- Department of Medicine II, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Marjot
- Oxford Liver Unit, Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, University of Oxford, UK
| | - Philip N. Newsome
- National Institute for Health Research, Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Liver & Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Mario U. Mondelli
- Division of Infectious Diseases and Immunology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Mojca Maticic
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Slovenia
| | - Elisa Cordero
- Department of Medicine, University of Seville, Clinical Unit of Infectious Diseases University Hospital Virgen del Rocio, Institute of Biomedicine, Sevilla, CSIC, Spain
| | - Rajiv Jalan
- Liver Failure Group, Institute for Liver and Digestive Health, University College London, London, UK
| | - Richard Moreau
- Inserm, Université de Paris, U1149, Centre de Recherche sur l'Inflammation (CRI), UMRS1149, Paris, France
- Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
- Centre for Individualised Infection Medicine (CIIM), Hannover, Germany
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
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