M Multi-Organ Histopathological Changes in SARS COV2 Infection: A Systematic Review and Meta-analysis

Abstract

Background: The World Health Organization has officially acknowledged the emergence of Coronavirus Disease 2019 (COVID-19), attributed to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, as a rapidly escalating global public health issue and declared it a pandemic. SARS-CoV-2 infection can lead to varied and multiorgan pathologies, with the most notable impacts occurring in the lungs (characterized by phases of diffuse alveolar damage, microthrombi, and bronchopneumonia), heart (involving lymphocytic myocarditis), kidney (resulting in acute tubular injury), and vasculature (involving microthrombi and deep vein thrombi). Objectives: To summarize, resolve contradiction and provide solid evidence on multiorgan histopathological changes caused by SARS-CoV2 infection.   Material and method: Histological data obtained from autopsy and biopsy studies were gathered following the guidelines of the Preferred Reporting Items for Systematic Review (PRISMA). An extensive electronic search was conducted on databases such as PubMed, Science Direct, Scopus, and Google Scholar, covering the period from database inception to March 2022. The collected studies underwent a systematic literature search, and a thorough critical review was performed. Result: After excluding studies that did not meet the eligibility criteria, a total of 58 articles were included in the review. We estimate the histopathological findings of 13 organ. For the pool proportion of exudative, proliferative and fibrotic phase of diffuse alveolar damage of lung is (70.666%, 56.126% and 33.031%) respectively. For liver steotosis is 35.808%. For acute tubular injury of kidney is 74.872%. For adrenal cortical necrosis is 13.113%. For brain gliosis is 13.865%. For heart necrosis is 5.477%. For gastrointestinal tract the pool proportion of inflammatory cells infiltration is 6.171%. For placental infarction is 25.684%. For orchitis is 29.019%. For perivascular inflammation of skin is 35.176%. For lymphocytic depletion of white pulp of spleen is 69.204%. For hemophagiocytosis of lymph node is 7.022%. For bone marrow fibrosis is 8.473%. Conclusion: COVID-19 is characterized as a multiorgan infection closely associated with a hyperinflammatory state, believed to initiate with diffuse alveolar damage and immuno-thrombotic microangiopathy. The extensive activation of the immune system and microvascular damage may contribute to indirect harm to other organs, although the direct impact of the virus on these tissues cannot be ruled out.