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High Prevalence of Pre-Existing Liver Abnormalities Identified Via Autopsies in COVID-19: Identification of a New Silent Risk Factor?

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dc.contributor.authorHirayama, Yuri
dc.contributor.authorDaniels, Natasha Faye
dc.contributor.authorEvans, Shelley
dc.contributor.authorClarke, David
dc.contributor.authorPurvis, Stephenie
dc.contributor.authorOliver, Charlotte
dc.contributor.authorWoodmansey, Stephen
dc.contributor.authorStaniforth, Joy
dc.contributor.authorSoilleux, Elizabeth J
dc.contributor.orcidDaniels, Natasha Faye [0000-0003-0384-0542]
dc.contributor.orcidEvans, Shelley [0000-0003-3242-6017]
dc.contributor.orcidStaniforth, Joy [0000-0003-2817-0098]
dc.contributor.orcidSoilleux, Elizabeth J [0000-0002-4032-7249]
dc.date.accessioned2021-10-30T01:12:37Z
dc.date.available2021-10-30T01:12:37Z
dc.date.issued2021-09-17
dc.date.updated2021-10-30T01:12:36Z
dc.description.abstractA high prevalence of hepatic pathology (in 17 of 19 cases) was reported in post-mortem (PM) examinations of COVID-19 patients, undertaken between March 2020 and February 2021 by a single autopsy pathologist in two English Coronial jurisdictions. The patients in our cohort demonstrated high levels of recognised COVID-19 risk factors, including hypertension (8/16, 50%), type 2 diabetes mellitus (8/16, 50%) and evidence of arteriopathy 6/16 (38%). Hepatic abnormalities included steatosis (12/19; 63%), moderate to severe venous congestion (5/19; 26%) and cirrhosis (4/19; 21%). A subsequent literature review indicated a significantly increased prevalence of steatosis (49%), venous congestion (34%) and cirrhosis (9.3%) in COVID-19 PM cases, compared with a pre-pandemic PM cohort (33%, 16%, and 2.6%, respectively), likely reflecting an increased mortality risk in SARS-CoV-2 infection for patients with pre-existing liver disease. To corroborate this observation, we retrospectively analysed the admission liver function test (LFT) results of 276 consecutive, anonymised COVID-19 hospital patients in our centre, for whom outcome data were available. Of these patients, 236 (85.5%) had significantly reduced albumin levels at the time of admission to hospital, which was likely indicative of pre-existing chronic liver or renal disease. There was a strong correlation between patient outcome (length of hospital admission or death) and abnormal albumin at the time of hospital admission (<i>p</i> = 0.000012). We discuss potential mechanisms by which our observations of hepatic dysfunction are linked to a risk of COVID-19 mortality, speculating on the importance of recently identified anti-interferon antibodies.
dc.identifier.citationDiagnostics (Basel, Switzerland), volume 11, issue 9
dc.identifier.doi10.17863/CAM.77529
dc.identifier.issn2075-4418
dc.identifier.otherPMC8467907
dc.identifier.other34574044
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/330085
dc.languageeng
dc.rightsAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.sourceessn: 2075-4418
dc.sourcenlmid: 101658402
dc.subjectPathology
dc.subjectCirrhosis
dc.subjectLiver function tests
dc.subjectAutopsy
dc.subjectSteatosis
dc.subjectPost-mortem
dc.subjectHepatic Pathology
dc.subjectCovid-19
dc.subjectSars-cov-2
dc.subjectInterferon Dysregulation
dc.titleHigh Prevalence of Pre-Existing Liver Abnormalities Identified Via Autopsies in COVID-19: Identification of a New Silent Risk Factor?
dc.typeArticle
rioxxterms.licenseref.urihttps://creativecommons.org/licenses/by/4.0/
rioxxterms.versionVoR
rioxxterms.versionofrecord10.3390/diagnostics11091703

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