{"doi":"10.1016/j.jcmgh.2020.10.003","title":"Liver Biopsy Shines a Light on COVID-19-Related Liver Injury","abstract":"Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 19 (COVID-19), has, within the span of less than a year, gone from a localized outbreak in Wuhan, China to a pandemic affecting essentially every country in the world. More than 34 million people have been infected and more than a million have died as of October 1, 2020. Patients at greatest risk for severe illness requiring hospitalization are those that are older and those with comorbidities including obesity, diabetes, and heart disease.1Xie Y. Wang Z. Liao H. Marley G. Wu D. Tang W. Epidemiologic, clinical, and laboratory findings of the COVID-19 in the current pandemic: systematic review and meta-analysis.BMC Infect Dis. 2020; 20: 640Crossref PubMed Scopus (91) Google Scholar Although the most common complication is acute respiratory distress syndrome and sepsis, a variety of extrapulmonary manifestations have been reported, including injury to the central nervous system, heart, kidneys, and the liver. A recent meta-analysis found that 3.6% of patients with COVID-19 had preexisting chronic liver disease but 23% had elevated liver enzyme tests at presentation.2Kulkarni A.V. Kumar P. Tevethia H.V. Premkumar M. Arab J.P. Candia R. Talukdar R. Sharma M. Qi X. Rao P.N. Reddy D.N. Systematic review with meta-analysis: liver manifestations and outcomes in COVID-19.Aliment Pharmacol Ther. 2020; 52: 584-599Crossref PubMed Scopus (156) Google Scholar During follow-up a further 24% develop liver enzyme elevations. Patients with liver injury are at risk for severe COVID-19 disease, although a causal relationship has not been established. There are many potential causes for liver injury during SARS-CoV-2 infection, including exacerbation of underlying chronic liver disease; drug injury; direct viral infection of the liver; and secondary injury to the liver caused by complications of illness, such cytokine-mediated injury and shock. Most of the information on the histologic changes in the liver have come from autopsies. The most common reported findings are fatty liver disease, chronic viral hepatitis, and zone 3 necrosis, the latter likely caused by hypoxic/ischemic injury.3Bradley B.T. Maioli H. Johnston R. Chaudhry I. Fink S.L. Xu H. Najafian B. Deutsch G. Lacy J.M. Williams T. Yarid N. Marshall D.A. Histopathology and ultrastructural findings of fatal COVID-19 infections in Washington State: a case series.Lancet. 2020; 396: 320-332Abstract Full Text Full Text PDF PubMed Scopus (526) Google Scholar Some authors have reported the presence of platelet microthrombi in sinusoids, but the significance of this finding is unclear because it is not always associated with necrosis.4Rapkiewicz A.V. Mai X. Carsons S.E. Pittaluga S. Kleiner D.E. Berger J.S. Thomas S. Adler N.M. Charytan D.M. Gasmi B. Hochman J.S. Reynolds H.R. Megakaryocytes and platelet-fibrin thrombi characterize multi-organ thrombosis at autopsy in COVID-19: a case series.EClinicalMedicine. 2020; 24: 100434Abstract Full Text Full Text PDF PubMed Scopus (372) Google Scholar However, autopsies have many limitations. Death may occur long after the acute liver injury was noted, and the histologic changes may have resolved or been obscured. Viral load diminishes with time and it is unusual to find viral RNA or proteins outside the lung.5Massoth L.R. Desai N. Szabolcs A. Harris C.K. Neyaz A. Crotty R. Chebib I. Rivera M.N. Sholl L.M. Stone J.R. Ting D.T. Deshpande V. Comparison of RNA in situ hybridization and immunohistochemistry techniques for the detection and localization of SARS-CoV-2 in human tissues.Am J Surg Pathol. 2020; https://doi.org/10.1097/PAS.0000000000001563Crossref PubMed Scopus (62) Google Scholar To understand what is happening in the liver at the time of the acute injury, it would be important to perform a liver biopsy. However, liver biopsies are seldom performed in patients with COVID-19 because there are often more pressing clinical issues than liver enzyme elevati","journal":"Cellular and Molecular Gastroenterology and Hepatology","year":2020,"id":90418,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":8,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9658,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":225662,"name":"David E. Kleiner","orcid":"0000-0003-3442-4453","position":0,"is_corresponding":true}],"reference_count":7,"raw_metadata":null,"created_at":"2026-07-18T22:02:48.683291Z","pmid":"33144089","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}