{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T11:02:47Z","timestamp":1769079767050,"version":"3.49.0"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,10,11]],"date-time":"2021-10-11T00:00:00Z","timestamp":1633910400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Although the pathologic investigation of liver injury was observed in a couple of cases in China, the detailed description of liver histopathologic and ultrastructural changes in a relatively larger series of liver tissues from COVID-19 patients is lacking. Samples from the liver were obtained from 24 COVID-19 cases from February 1 to April 1, 2020. Light microscopy showed that all liver sections had different degrees of liver injury manifested as swelling of the hepatocytes, hepatocellular necrosis, steatosis, lobular inflammation, portal inflammation, dilatation of sinusoids, and so on. SARS-CoV-2 induced liver injury might be independent of pre-existing Schistosoma infection or obstructive cholestasis. Patients combined with respiratory failure had more severe hepatocellular necrosis and male patients were more susceptible to liver injury. Although coronavirus particles or viral inclusions were not detected in the liver tissues for all cases, vacuolar degenerations in hepatocytes, edematous of mitochondria with the disruption of cristae, and expansions of the endoplasmic reticulum were observed. In conclusion, pathologic changes of liver tissues provide us a further understanding of liver injury in COVID-19 patients. Changes in the liver seem to be related to the underlying diseases\/conditions.<\/jats:p>","DOI":"10.3389\/fmed.2021.749318","type":"journal-article","created":{"date-parts":[[2021,10,13]],"date-time":"2021-10-13T15:39:09Z","timestamp":1634139549000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":17,"title":["Liver Histopathological Analysis of 24 Postmortem Findings of Patients With COVID-19 in China"],"prefix":"10.3389","volume":"8","author":[{"given":"Huikuan","family":"Chu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Peng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lilin","family":"Hu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yixin","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinfang","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hua","family":"Su","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lin","family":"Yao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qingjing","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiu","family":"Nie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ling","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaohua","family":"Hou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,10,11]]},"reference":[{"key":"B1","unstructured":"Weekly Operational Update on COVID-19 25 September 20202000"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1001\/jama.2020.1585","article-title":"Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China","volume":"323","author":"Wang","year":"2020","journal-title":"JAMA."},{"key":"B3","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1016\/S2213-2600(20)30079-5","article-title":"Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study","volume":"8","author":"Yang","year":"2020","journal-title":"Lancet Respir Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1775","DOI":"10.1093\/infdis\/jiaa113","article-title":"A 55-day-old female infant infected with 2019 novel coronavirus disease: presenting with pneumonia, liver injury, and heart damage","volume":"221","author":"Cui","year":"2020","journal-title":"J Infect Dis"},{"key":"B5","doi-asserted-by":"publisher","first-page":"139","DOI":"10.3760\/cma.j.issn.0254-6450.2020.02.002","article-title":"An update on the epidemiological characteristics of novel coronavirus pneumonia COVID-19","volume":"41","year":"2020","journal-title":"Zhonghua Liu Xing Bing Xue Za Zhi"},{"key":"B6","doi-asserted-by":"publisher","first-page":"m606","DOI":"10.1136\/bmj.m606","article-title":"Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series","volume":"368","author":"Xu","year":"2020","journal-title":"BMJ"},{"key":"B7","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1016\/S1473-3099(20)30086-4","article-title":"Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study","volume":"20","author":"Shi","year":"2020","journal-title":"Lancet Infect Dis."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical characteristics of Coronavirus Disease 2019 in China","volume":"382","author":"Guan","year":"2020","journal-title":"N Engl J Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1016\/S0140-6736(20)30183-5","article-title":"Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China","volume":"395","author":"Huang","year":"2020","journal-title":"Lancet"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e0235458","DOI":"10.1371\/journal.pone.0235458","article-title":"Clinical characteristics of 82 cases of death from COVID-19","volume":"15","author":"Zhang","year":"2020","journal-title":"PLoS ONE"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2110","DOI":"10.1111\/liv.14601","article-title":"Liver histopathology in severe COVID 19 respiratory failure is suggestive of vascular alterations","volume":"40","author":"Sonzogni","year":"2020","journal-title":"Liver Int"},{"key":"B12","doi-asserted-by":"publisher","first-page":"7693","DOI":"10.3748\/wjg.v26.i48.7693","article-title":"High prevalence of hepatic steatosis and vascular thrombosis in COVID-19: a systematic review and meta-analysis of autopsy data","volume":"26","author":"Diaz","year":"2020","journal-title":"World J Gastroenterol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1016\/S0140-6736(20)31305-2","article-title":"Histopathology and ultrastructural findings of fatal COVID-19 infections in Washington State: a case series","volume":"396","author":"Bradley","year":"2020","journal-title":"Lancet."},{"key":"B14","doi-asserted-by":"publisher","first-page":"2147","DOI":"10.1038\/s41379-020-00649-x","article-title":"Hepatic pathology in patients dying of COVID-19: a series of 40 cases including clinical, histologic, and virologic data","volume":"33","author":"Lagana","year":"2020","journal-title":"Mod Pathol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.humpath.2020.11.015","article-title":"Pathological findings in the postmortem liver of patients with coronavirus disease 2019 (COVID-19)","volume":"109","author":"Zhao","year":"2021","journal-title":"Hum Pathol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1016\/j.jhep.2020.05.002","article-title":"SARS-CoV-2 infection of the liver directly contributes to hepatic impairment in patients with COVID-19","volume":"73","author":"Wang","year":"2020","journal-title":"J Hepatol"},{"key":"B17","first-page":"1","article-title":"Pathologic diagnosis and grading guideline of common pathological changes after liver transplantation (II)","volume":"3","year":"2015","journal-title":"Prac J Organ Transplant."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1513","DOI":"10.1002\/hep.1840190629","article-title":"Classification of chronic hepatitis: diagnosis, grading and staging","volume":"19","author":"Desmet","year":"1994","journal-title":"Hepatology."},{"key":"B19","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1016\/0168-8278(91)90084-O","article-title":"Classification of chronic viral hepatitis: a need for reassessment","volume":"13","author":"Scheuer","year":"1991","journal-title":"J Hepatol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1101\/2020.02.03.931766","article-title":"Specific ACE2 expression in cholangiocytes may cause liver damage after 2019-nCoV infection","author":"Chai","year":"2020","journal-title":"bioRxiv"},{"key":"B21","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1002\/hep.30203","article-title":"Creg in hepatocytes ameliorates liver ischemia\/reperfusion injury in a TAK1-dependent manner in mice","volume":"69","author":"Yang","year":"2019","journal-title":"Hepatology."},{"key":"B22","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1177\/0956462419826723","article-title":"A case of late presentation of darunavir-related cholestatic hepatitis","volume":"30","author":"Yancheva","year":"2019","journal-title":"Int J STD AIDS."},{"key":"B23","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1016\/S2213-2600(16)30435-0","article-title":"Intravenous zanamivir or oral oseltamivir for hospitalised patients with influenza: an international, randomised, double-blind, double-dummy, phase 3 trial","volume":"5","author":"Marty","year":"2017","journal-title":"Lancet Respir Med."},{"key":"B24","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1016\/j.jhep.2020.04.006","article-title":"COVID-19: abnormal liver function tests","volume":"73","author":"Cai","year":"2020","journal-title":"J Hepatol."},{"key":"B25","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1016\/j.jhep.2020.03.044","article-title":"Non-alcoholic fatty liver diseases in patients with COVID-19: a retrospective study","volume":"73","author":"Ji","year":"2020","journal-title":"J Hepatol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.749318\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,13]],"date-time":"2021-10-13T15:39:15Z","timestamp":1634139555000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.749318\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,11]]},"references-count":25,"alternative-id":["10.3389\/fmed.2021.749318"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2021.749318","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,11]]},"article-number":"749318"}}