High prevalence of hepatic steatosis and vascular thrombosis in COVID-19: A systematic review and meta-analysis of autopsy data

Luis Antonio Díaz, Francisco Idalsoaga, Macarena Cannistra, Roberto Candia, Daniel Cabrera, Francisco Barrera, Alejandro Soza, Rondell Graham, Arnoldo Riquelme, Marco Arrese, Michael D. Leise, Juan Pablo Arab*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

49 Scopus citations


BACKGROUND Coronavirus disease 2019 (COVID-19) disease can frequently affect the liver. Data on hepatic histopathological findings in COVID-19 is scarce. AIM To characterize hepatic pathological findings in patients with COVID-19. METHODS We conducted a systematic review with meta-analysis registered on PROSPERO (CRD42020192813), following PRISMA guidelines. Eligible trials were those including patients of any age and COVID-19 diagnosis based on a molecular test. Histopathological reports from deceased COVID-19 patients undergoing autopsy or liver biopsy were reviewed. Articles including less than ten patients were excluded. Proportions were pooled using random-effects models. Q statistic and I2 were used to assess heterogeneity and levels of evidence, respectively. RESULTS We identified 18 studies from 7 countries; all were case reports and case series from autopsies. All the patients were over 15 years old, and 67.2% were male. We performed a meta-analysis of 5 studies, including 116 patients. Pooled prevalence estimates of liver histopathological findings were hepatic steatosis 55.1% [95% confidence interval (CI): 46.2-63.8], congestion of hepatic sinuses 34.7% (95%CI: 7.9-68.4), vascular thrombosis 29.4% (95%CI: 0.4-87.2), fibrosis 20.5% (95%CI: 0.6-57.9), Kupffer cell hyperplasia 13.5% (95%CI: 0.6-54.3), portal inflammation 13.2% (95%CI: 0.1-48.8), and lobular inflammation 11.6% (95%CI: 0.3-35.7). We also identified the presence of venous outflow obstruction, phlebosclerosis of the portal vein, herniated portal vein, periportal abnormal vessels, hemophagocytosis, and necrosis. CONCLUSION We found a high prevalence of hepatic steatosis and vascular thrombosis as major histological liver features. Other frequent findings included portal and lobular inflammation and Kupffer cell hyperplasia or proliferation. Further studies are needed to establish the mechanisms and implications of these findings.

Original languageEnglish
Pages (from-to)7693-7706
Number of pages14
JournalWorld Journal of Gastroenterology
Issue number48
StatePublished - 28 Dec 2020
Externally publishedYes

Bibliographical note

Publisher Copyright:
© The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.


  • Autopsies
  • COVID-19
  • Liver
  • Liver biopsies
  • Pathology
  • SARS-CoV-2


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