Table 2.
Histological Findings of the Liver in COVID-19 and Their Correlation With Elevated Liver Enzymes.
| Histological parameters | All cases (n = 41) | Normal AST or ALT N = 8 [I] | AST or ALT 1X-2X (n = 18) [II] | AST or ALT >2X (n = 14) [III] | P value I vs II + III |
P value I vs III |
|---|---|---|---|---|---|---|
| Macrovesicular steatosis | 29 (70.7%) | 8 (100%) | 13 (72.2%) | 8 (57.1%) | 0.080 | 0.051 |
| Mild | 16 (39%) | 3 (37.5%) | 8 (44.4%) | 5 (35.7%) | ||
| Moderate | 11 (26.8%) | 5 (62.5%) | 4 (22.2%) | 2 (14.3%) | ||
| Severe | 2 (4.8%) | 0 | 1 (5.5%) | 1 (7.1%) | ||
| Lobular necroinflammation | 10 (24.4%) | 0 | 5 (27.7%) | 5 (35.7%) | 0.165 | 0.115 |
| Rare individual apoptosis | 8∗ (19.5%) | 1 (12.5%) | 2 (11.1%) | 4 (28.6%) | 1.000 | 0.613 |
| Portal inflammation | 13 (31.7%) | 2 (25%) | 5 (27.7%) | 6 (42.8%) | 1.000 | 0.649 |
| Mild | 11 (26.8%) | 1 (12.5%) | 5 (27.7%) | 5 (35.7%) | ||
| Moderate | 2 (4.8%) | 1 (12.5%) | 0 | 1 (7.1%) | ||
| Severe | 0 | 0 | 0 | 0 | ||
| Fibrosis | 8$& | 2a (25%) | 1b (5.5%) | 5c (35.7%) | 0.649 | 1.000 |
| Centrilobular ischemic necrosis | 11 (26.8%) | 3 (37.5%) | 5 (27.7%) | 3 (21.4%) | 0.660 | 0.624 |
| Cholestasis (all mild) | 17∗ (41.5%) | 5 (62.5%) | 7 (38.9%) | 4 (28.6%) | 0.229 | 0.187 |
| Increased portal vascular channels | 24∗ (58.5%) | 4 (50%) | 10 (55.5%) | 9 (64.3%) | 0.702 | 0.661 |
| Sinusoidal microthrombi | 5∗ (12.2%) | 0 | 3 (16.6%) | 1 (7.1%) | 0.565 | 1.000 |
| Sinusoidal congestion with neutrophil influx | 14 (34.1%) | 1 (12.5%) | 8 (44.4%) | 5 (35.7%) | 0.221 | 0.351 |
| Kupffer cell prominence | 9∗ (21.9%) | 1 (12.5%) | 2# (11.1%) | 5# (35.7%) | 1.000 | 0.351 |
AST, aspartate aminotransferase; AST, alanine aminotransferase.
∗AST/ALT value not available in one case; # includes one case with Kupffer hemophagocytosis; $ includes one case of cirrhosis, three cases with stage 3 fibrosis, and four cases with stage 1 fibrosis (Ishak staging system); & excludes three cases of zone 3 pericellular fibrosis; a represents one case with stage 1 fibrosis and one case with stage 3 fibrosis; b represents one case with stage 3 fibrosis; c represents three cases with stage 1 fibrosis, one case with stage 3 fibrosis, and 1 case with cirrhosis.