SARS-CoV-2 infection of the liver directly contributes to hepatic impairment in patients with COVID-19

JOURNAL OF HEPATOLOGY

卷:73

Article

Wang, Yijin¹  Liu, Shuhong¹  Liu, Hongyang¹  Li, Wei²  Lin, Fang³  Jiang, Lina¹  Li, Xi¹  Xu, Pengfei¹  Zhang, Lixin¹  Zhao, Lihua¹  Cao, Yun²  Kang, Jiarui⁴  Yang, Jianfa¹  Li, Ling¹  Liu, Xiaoyan¹  Li, Yan¹  Nie, Ruifang¹  Mu, Jinsong³  Lu, Fengmin^5,6  Zhao, Shousong²  Lu, Jiangyang⁴  Zhao, Jingmin¹ 

[1] Chinese Peoples Liberat Army Gen Hosp, Dept Pathol & Hepatol, Med Ctr 5, 100 Xi Si Huan Middle Rd, Beijing, Peoples R China

[2] First Affiliated Hosp, Dept Infect Dis, Bengbu Med Coll, Bengbu, Peoples R China

[3] Chinese Peoples Liberat Army Gen Hosp, Dept Intens Care Unit, Med Ctr 5, Beijing, Peoples R China

[4] Chinese Peoples Liberat Army Gen Hosp, Dept Pathol, Med Ctr 4, Beijing, Peoples R China

[5] Peking Univ, Dept Microbiol, Sch Basic Med Sci, Hlth Sci Ctr, Beijing, Peoples R China

[6] Peking Univ, Infect Dis Ctr, Sch Basic Med Sci, Hlth Sci Ctr, Beijing, Peoples R China

关键词: COVID-19;    Liver enzyme abnormality;    Transaminase;    SARS-CoV-2 infection;    Cytopathy;   

DOI  :  10.1016/j.jhep.2020.05.002

来源: Elsevier

【 摘 要 】

Background & Aims: Liver enzyme abnormalities are common in patients with coronavirus disease 2019 (COVID-19). Whether or not severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can lead to liver damage per se remains unknown. Herein, we reported the clinical characteristics and liver pathological manifestations of COVID-19 patients with liver enzyme abnormalities. Methods: We analyzed 156 patients diagnosed with COVID-19 from 2 designated centers in China and compared clinical features between patients with or without elevated aminotransferases. Postmortem liver biopsies were obtained from 2 cases who had elevated aminotransferases. We investigated the patterns of liver impairment by electron microscopy, immunohistochemistry, TUNEL assay and pathological studies. Results: Sixty-four out of 156 (41.0%) patients with COVID-19 had elevated aminotransferases. The median levels of alanine aminotransferase were 50 la vs. 19 UAL, respectively, aspartate aminotransferase were 45.5 la vs. 24 la, respectively in abnormal and normal aminotransferase groups. Liver enzyme abnormalities were associated with disease severity, as well as a series of laboratory tests including higher alveolar-arterial oxygen partial pressure difference, higher gammaglutamyltransferase, lower albumin, decreased CD4+ T cells and B lymphocytes. Ultrastructural examination identified typical coronavirus particles, characterized by spike structures, in the cytoplasm of hepatocytes in 2 COVID-19 cases. SARS-CoV-2-infected hepatocytes displayed conspicuous mitochondrial swelling, endoplasmic reticulum dilatation and glycogen granule decrease. Histologically, massive hepatic apoptosis and some binuclear hepatocytes were observed. Taken together, both ultrastructural and histological evidence indicated a typical lesion of viral infection. Immunohistochemical results showed scarce CD4+ and CD8+ lymphocytes. No obvious eosinophil infiltration, cholestasis, fibrin deposition, granuloma, massive central necrosis, or interface hepatitis were observed. Conclusions: SARS-CoV-2 infection in the liver directly contributes to hepatic impairment in patients with COVID-19. Hence, a surveillance of viral clearance in liver and long-term outcome of COVID-19 is required. Lay summary: Liver enzyme abnormalities are common in patients with coronavirus disease 2019 (COVID-19). We reported the clinical characteristics and liver pathological manifestations of COVID-19 patients with elevated liver enzymes. Our findings suggested that SARS-CoV-2 infection of the liver is a crucial factor contributing to hepatic impairment in patients with COVID-19. (C) 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

【 授权许可】

Free