Hepatic Vasculopathy and Regenerative Responses of the Liver in Fatal Cases of COVID-19

Kaltschmidt, Barbara; Fitzek, Antonia; Schaedler, Julia; Förster, Christine; Kaltschmidt, Christian; Hansen, Thorsten; Steinfurth, Fabian; Windmöller, Beatrice A.; Pilger, Christian; Kong, Chen; Singh, Kashika; Nierhaus, Axel; Wichmann, Dominic; Sperhake, Jan; Püschel, Klaus; Huser, Thomas; Krüger, Martin; Robson, Simon C.; Wilkens, Ludwig; Esch, Jan Schulte Am

doi:10.1016/j.cgh.2021.01.044

Cited by 34 publications

(42 citation statements)

References 8 publications

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“…It is noteworthy that the histological changes in the lungs were heterogeneously distributed, which corresponds with our radiological ndings of patchy dullness opacities, which most likely indicate a diffuse spread of the virus in the respiratory tract [28,29]. In addition, multi-site organ tropism has been reported to be favoured in tissues with high expression of the angiotensin converting enzyme 2 receptor [6,[30][31][32][33][34][35][36]. As venous thromboembolism was increasingly seen as a complication, since the beginning of May 2020, adapted anticoagulation has also been used in intensive care in Hamburg [7,28].…”

Section: Discussionsupporting

confidence: 85%

Dying From Or With SARS-CoV-2 – Prospective Postmortem Evaluation of 735 Consecutive Death Cases –

Fitzek

Schädler

Dietz

et al. 2021

Preprint

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BackgroundCoronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic with significant mortality. Accurate information on the specific circumstances of death and whether patients died from or with SARS-CoV-2 is scarce.MethodsTo distinguish COVID-19 from non-COVID-19 deaths, we performed a systematic review of 735 SARS-CoV-2-associated deaths in Hamburg, Germany, from March to December 2020, using conventional autopsy, ultrasound-guided minimally invasive autopsy, postmortem computed tomography and medical records. Statistical analyses including multiple logistic regression were used to compare both cohorts.Findings84.1% (n=618) were classified as COVID-19 deaths, 6.4% (n=47) as non-COVID-19 deaths, 9.5% (n=70) remained unclear. Median age of COVID-19 deaths was 83.0 years, 54.4% were male. In the autopsy group (n=283), the majority died of pneumonia and/or diffuse alveolar damage (73.6%; n=187). Thromboses were found in 39.2% (n=62/158 cases), pulmonary embolism in 22.1% (n=56/253 cases). In 2020, annual mortality in Hamburg was about 5.5% higher than in the previous 20 years, of which 3.4% (n=618) represented COVID-19 deaths.InterpretationOur study highlights the need for mortality surveillance and postmortem examinations. The vast majority of individuals who died directly from SARS-CoV-2 infection were of advanced age and had multiple comorbidities.

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Section: Discussionsupporting

confidence: 85%

Dying From Or With SARS-CoV-2 – Prospective Postmortem Evaluation of 735 Consecutive Death Cases –

Fitzek

Schädler

Dietz

et al. 2021

Preprint

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“…Colonoscopy, in particular, demonstrated an ulcerative lesion of the left colonic flexure, which was histologically diagnosed as ischemic colitis. PCR-analysis on biopsy specimens, following a previously reported method (Kaltschmidt et al, 2021), was negative for SARS-CoV-2. Treatment was supportive with mesalazine and intravenous iron substitution.…”

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confidence: 86%

“…We conducted molecular mapping of 9 different anatomical parts of formalin-fixed paraffin-embedded tissue as previously described (Kaltschmidt et al, 2021). RNA was extracted from paraffin sections using the Maxwell RSC (Promega, Madison, WI, USA).…”

mentioning

confidence: 99%

First case of postmortem study in a patient vaccinated against SARS-CoV-2

Hansen¹,

Titze²,

Kulamadayil-Heidenreich³

et al. 2021

International Journal of Infectious Diseases

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A previously symptomless 86-year-old man received single mRNA vaccine BNT162b2. Four weeks later, he succumbed to death due to acute renal and respiratory failure. Although he did not present with any symptoms specific for Coronavirus disease 19 (COVID19), he obtained positive testing for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), before he died. S1 antigen-binding notably showed significant levels for IgG, while nucleocapsid IgG/IgM was not elicited . By means of autopsy, acute bronchopneumonia and acute tubular failure were assigned as cause death of death. However, we did not observe any characteristic morphological features of COVID19. Postmortem molecular mapping by real time-polymerase chain reaction (RT-PCR) additionally revealed relevant SARS-CoV-2 Ct values in all organs examined (oropharynx, olfactory mucosa, trachea, lungs, heart, kidney, and cerebrum) except for liver and olfactory bulb. These results might contribute to the view that first vaccination induces immunogenicity, but not sterile immunity.

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“…Importantly, SARS-CoV-2 RNA and nucleo-capsid protein have been detected in the cholangiocytes and bile of patients with fatal COVID-19 pneumonia, suggesting that a direct cytopathic effect may occur [ 5 ]. Moreover, endothelialitis resulting in hypercoagulability and microthrombi deposition in the peribiliary vascular plexus may aggravate ischemia of the biliary epithelium.…”

mentioning

confidence: 99%

Secondary sclerosing cholangitis: an emerging complication in critically ill COVID-19 patients

et al. 2021

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Hepatic Vasculopathy and Regenerative Responses of the Liver in Fatal Cases of COVID-19

Cited by 34 publications

References 8 publications

Dying From Or With SARS-CoV-2 – Prospective Postmortem Evaluation of 735 Consecutive Death Cases –

Dying From Or With SARS-CoV-2 – Prospective Postmortem Evaluation of 735 Consecutive Death Cases –

First case of postmortem study in a patient vaccinated against SARS-CoV-2

Secondary sclerosing cholangitis: an emerging complication in critically ill COVID-19 patients

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