Liver Damage and Impaired Coagulation in COVID-19 Patients: A Case Series

Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has generated an unprecedented challenge for healthcare systems worldwide. Currently, the scientific community wonders if liver injury in patients suffering from severe forms is a direct consequence of the virus or secondary manifestations of systemic inflammation. The liver plays an essential role in the development of the inflammatory storm typical of this disease, and its involvement is associated with worse clinical outcomes and a higher risk of morbidity and mortality from Coronavirus disease 2019 (COVID-19). Methods: Ten patients suffering from severe COVID-19 disease who died between January 2020 and December 2021 were included in the present analysis. These subjects underwent a post mortem examination with a focused evaluation of the hepatic injury. Also, several laboratory parameters have been evaluated, with a primary focus on prothrombin time, partial thromboplastin time, fibrinogen, antithrombin III, and D-dimers to detect coagulative changes. Results: The main cause of death was represented by pulmonary thromboembolism events (50%). The analysis of coagulation laboratory parameters and liver biomarkers revealed a statistically significant rise in aPTT and ALP, and a decrease in albumin, when comparing the blood value at admission and death. We also found high levels of D-dimers in most of the subjects at the time of hospitalization. Interestingly, the post mortem analysis of the liver showed ample morphologic variability, with several disease features. In detail, the liver histology revealed the following: the presence of a variable degree of micro- and macrovacuolar steatosis, inflammation (also, hepato-cholangitis), and variable fibrosis. Of mention, we were also able to detect organized fibrinous material. Conclusions: Our results indicate that in subjects with a severe form of COVID-19, liver disease is related to changes in coagulative and fibrinolytic pathways. In particular, we noted low fibrinogen levels and high D-dimer levels with histological liver findings. Our data suggest that fibrinogen and D-dimers may be used as prognostic markers to detect the severity of liver disease in patients with COVID-19. Finally, we underline the crucial role of coagulation balance in subjects with severe forms of COVID-19.

Role of Perturbated Hemostasis in MASLD and Its Correlation with Adipokines

“…The available evidence indicates that fibrinogen and D-dimers have the potential to serve as prognostic indicators for assessing the degree of liver disease in individuals with COVID-19. This highlights the significant involvement of coagulation balance in patients experiencing severe manifestations of COVID-19 [137]. Moreover, it is usual to observe altered levels of PAI-1 during infection, which are often linked to a condition of reduced fibrinolysis and the occurrence of thrombotic problems.…”

“…These characteristics exhibit clinical significance, leading to the occurrence of thrombosis in various anatomical regions [133][134][135][136]. A recent study by Abenavoli et al (2023) discovered that individuals with a severe manifestation of COVID-19 exhibit a correlation between liver illness and changes in coagulative and fibrinolytic pathways [137]. Specifically, the researchers observed decreased levels of fibrinogen and increased levels of D-dimer, together with histological liver abnormalities.…”