A report from Germany provides more evidence that SARS-CoV-2 can invade the liver and cause damage. "Our study demonstrates once again that COVID-19 is a systemic disease and that SARS-CoV-2 damages the liver and results in vascular injury," Dr. Jan Schulte am Esch of the University Hospital of Bielefeld told Reuters Health by email. He and his colleagues analyzed liver tissue obtained at autopsy from 60 patients who died of COVID-19 pneumonia in Hamburg between March and June, as well as a control of 13 patients who died of pneumonia but did not have SARS-CoV-2 infection. Only five patients with COVID-19 and one control had a history of liver disease, the team reports in Clinical Gastroenterology and Hepatology. "We show in this paper the essential elements of the liver pathology that result in the abnormal hepatic function, seen in severe forms of COVID-19. The changes manifest as thromboses of hepatic micro-vessels and sinusoids with aberrant hepatic regeneration responses, as has already been observed for other forms of viral hepatitis," Dr. Shulte am Esch told Reuters Health. "Interestingly, micro-thrombosis was significantly more common in those patients who died in nursing homes or in a home setting - in a care area where routine anticoagulation would be unusual," he noted. "The benefits of therapeutic or other levels of anticoagulation in COVID-19 are an ongoing source of controversy, given the high rates of bleeding complications with current approaches. However, our study may indicate a somewhat protective effect of systemic anticoagulation on the liver vasculature in severe disease and further studies are awaited with interest," Dr. Shulte am Esch added. The findings from Germany support a case series published recently in the American Journal of Gastroenterology describing three young adults who developed prolonged and severe liver disease during recovery from severe COVID-19. —Megan Brooks Source
