Higher frequency of hepatic steatosis at CT among COVID-19-positive patients

Abstract

Purpose Recent studies have demonstrated that obesity is significantly associated with increased disease severity, hospitalizations and mortality in COVID-19, with a potential role in the pathogenesis and prevalence in the new pandemic. The association with hepatic steatosis, however, a condition closely related to obesity within the spectrum of systemic metabolic dysfunctions, remains to be elucidated. We aimed to evaluate the frequency of hepatic steatosis as incidentally detected in chest CT examinations of COVID-19 positive patients in comparison to non-infected controls. Methods A retrospective study was performed with 316 patients (204 RT-PCR positive; 112 RT-PCR negative and chest CT negative). Steatosis was measured with placement of a single ROI in the right lobe of the liver (segments VI-VII) and defined as a liver attenuation value ≤ 40 HU. Results The frequency of hepatic steatosis was higher in the RT-PCR positive group in comparison to controls (31.9% vs. 7.1%, p < 0.001). Logistic linear regression analysis showed a 4.7 times odds of steatosis in the COVID-19 positive group as compared to controls after adjusting for age and sex (OR 4.698; 95% IC 2.12-10.41, p < 0.001). Conclusion A significantly higher prevalence of steatosis was found among COVID-19 positive individuals. These findings are in accordance with other recent studies linking obesity and COVID-19 infection, as there is an intricate relationship between liver steatosis, metabolic syndrome and obesity. Further studies are required to confirm if such association remains after accounting for multiple variables, as well as possible relationships with disease severity and worst clinical outcomes.

Multisystem Imaging Manifestations of COVID-19, Part 2: From Cardiac Complications to Pediatric Manifestations

“…The proportion of liver injury was also higher in patients with severe COVID-19 (63). Periportal necrosis, lymphocytic infiltration of the sinusoids, dense portal infiltration by abnormally small lymphocytes, central vein thrombosis, and cirrhotic changes with thick fibrosis were all findings at liver autopsy (64,65).…”

“…Periportal edema may be more apparent at both CT and MRI (Fig 16). There has also been increased prevalence of hepatic steatosis in patients with COVID-19 that is likely attributable to the known association between infection and obesity (64). In fact, it has been reported that hepatic steatosis is an independent risk factor of severe disease (67).…”

NAFLD and COVID-19: a Pooled Analysis

“…Other authors have proposed that the increased levels of inflammatory mediators, such as IL-1, IL-6, and IL-10 levels, may further contribute to damaging hepatocytes in COVID-19 patients [1]. Hepatic steatosis is a commonly observed finding in patients testing positive for SARS-CoV-2 [2]. The effect of fatty liver on the severity of COVID-19 illness has not yet been studied.…”

Infections at the nexus of metabolic-associated fatty liver disease

“…Considering that MAFLD patients often suffer from hypertension, insulin resistance and type 2 diabetes, their specific position during the SARS epidemics was and is largely unknown. Furthermore, COVID-19 patients show a higher occurrence of hepatic steatosis measured by thorax CT (Kreling et al 2020) and SARS-CoV and SARS-CoV-2 infections are often accompanied by abnormal levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) serum levels which suggest liver damage (Zhang et al 2020;Cui et al 2004). In addition, suffering from MAFLD increases the risk for developing severe COVID-19 in both diabetic and non-diabetic patients (Gao et al 2020;Dongiovanni et al 2020;Pan et al 2020).…”