Histopathological characteristics in livers of deceased patients with COVID-19

Introduction and Objectives: SARS-CoV-2 represents the causative agent of a potentially fatal disease, COVID-19, where the liver is one of the most affected organs. The following research aims to describe histopathological characteristics in the livers of deceased patients with COVID-19 and to identify possible associations with clinical and epidemiological variables.

Materials and Methods: An observational, descriptive, cross-sectional study was conducted with 559 deceased individuals over 19 years of age who underwent minimally invasive autopsies in various Cuban hospitals between October 2021 and December 2022. Epidemiological and liver histopathological data were analyzed. A logistic regression model was used to evaluate the variables that influence the likelihood of hepatocellular necrosis.

Results: The deceased were predominantly men (n = 323, 58.0 %), with a mean age of 69.4 ± 15.6 years. An acute necroinflammatory pattern was predominant, with hepatocellular necrosis present in (n = 486, 87.0%), particularly confluent necrosis (n = 285, 51.0%). Necrosis was associated with multimorbidity OR: 1,986 (1,055-3,737), microvacuolar steatosis (> 5 %) OR: 3,348 (1,188-9,439) and steatotic liver disease OR: 8,625 (3,093-24,050). Multivariate analysis confirmed steatotic liver disease Adjusted OR = 4.657; (95% CI: 1.872-14.985) and cirrhosis Adjusted OR = 8.294; (95% CI: 3.187-18.762) as significant predictors.

Conclusion: Hepatocellular necrosis, particularly confluent necrosis, was the predominant histopathological lesion in COVID-19 deaths in Cuba and was associated with steatotic liver disease and cirrhosis. These findings highlight the importance of monitoring liver function in patients with preexisting liver conditions during and after SARS-CoV-2 infection.