Is Fatty Liver Associated with Increased Mortality and Morbidity in Coronavirus Disease 2019 (COVID-19) Pneumonia?

Madan, Kaushal; Rastogi, Ruchi; Bhargava, Richa; Dagar, Vineeta; Singla, Vikas; Sahu, Amit Kumar; Singh, Pankaj Kumar; Garg, Pallavi; Aggarwal, Bharat B.; Singh, Ramkrishna Kumar

doi:10.1016/j.jceh.2022.04.013

Cited by 15 publications

(21 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some of the studies including patients without NAFLD have positively correlated elevated transaminases with the severity of COVID-19 illness [ 25 , 26 ]. However, similar to ours, the study by Wang et al (included patients with NAFLD) and Madan et al didn’t find a significant correlation between elevated transaminases and severe events or mortality [ 10 , 19 ]. Surprisingly in sub-group analysis, we found a significantly higher number of patients who died during hospital stay (In both NAFLD and non-NAFLD groups) actually had lower AST levels at admission.…”

Section: Discussionsupporting

confidence: 82%

“…In agreement with our study, one previous study by Wang et al has shown no relationship between the severity of COVID-19 and NAFLD, although they have shown higher mortality in patients with NAFLD having normal body mass index [ 19 ]. Similarly, the study by Madan et al also concluded that fatty liver may not be associated with high morbidity and mortality in patients with COVID-19 pneumonia [ 10 ]. In the latter two studies, fatty liver was diagnosed by ultrasonography and NCCT features, which were probably a more objective way of determining fatty liver [ 10 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, the study by Madan et al also concluded that fatty liver may not be associated with high morbidity and mortality in patients with COVID-19 pneumonia [ 10 ]. In the latter two studies, fatty liver was diagnosed by ultrasonography and NCCT features, which were probably a more objective way of determining fatty liver [ 10 , 19 ]. However, in contrast to all these studies, ours is a large single-center study that included COVID-19-infected hospitalized patients.…”

Section: Discussionmentioning

confidence: 99%

“…A few, but not all, studies have also reported higher morbidity and mortality [ 8 , 9 ]. In a small case-control study conducted at a tertiary care hospital in India, Madan et al found no association between the presence of fatty liver and COVID-19-associated clinical outcomes (Morbidity and mortality) [ 10 ]. However, large studies showing an association between the presence of fatty liver and the severity of COVID-19 infection are lacking at present.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Effect of Nonalcoholic Fatty Liver Disease (NAFLD) on COVID-19: A Single-Center Study of 3983 Patients With Review of Literature

Nath¹,

Kumar²,

Mallick³

et al. 2022

Cureus

View full text Add to dashboard Cite

BackgroundThe presence of metabolic syndrome (MS) is associated with increased disease severity in patients with coronavirus disease 2019 . Non-alcoholic fatty liver disease (NAFLD) associated with or without MS may be related to increased morbidity and mortality in COVID-19, but large Indian studies are lacking. The present study was carried out to assess the impact of NAFLD on the clinical outcomes in patients with COVID-19 infection. MethodsAll patients with COVID-19 hospitalized at a tertiary care hospital in eastern India from April 4 to December 31, 2020, were included in the study. Patients who underwent non-contrast CT (NCCT) chest were evaluated for the presence of hepatic steatosis based on a validated criterion liver attenuation (HU) value lower than the spleen, absolute liver attenuation lower than 40 HU, and liver to spleen attenuation ratio less than 1. Patients were divided into two groups, those with or without fatty liver. Baseline characteristics including age, sex, liver function tests, and outcomes including duration of hospital stay and mortality were compared. ResultsA total of 6003 COVID-19-positive patients were admitted during the study period. Of these patients, 214 children (<18 years) with COVID-19 infection were excluded. One hundred and eight patients with a history of significant ethanol abuse were excluded from the analysis. NCCT scan was not done in 1698 patients. Finally, 3983 patients were included in the study. They were divided into two groups depending on the presence or absence of NAFLD. Of the 3983 patients, 814 (20.4%) had NAFLD. Overall in-hospital mortality among the study group was 6.4%. The mortality rate among patients with NAFLD was 6.7% while that in patients without fatty liver was 6% (P=0.381). Similarly, the mean duration of hospital stay was also comparable between both the groups (10.63±7.2days vs 10.65±6.6 days; P=0.66). Prevalence of NAFLD was similar in survivors and non-survivors; 759 of 2981 patients (25.4%) and 55 of 188 patients 29.2% (P=0.381), respectively. On univariate analysis, male sex, older age, elevated alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transpeptidase (GGT) along with low serum albumin and low absolute eosinophil counts (AEC) were associated with higher mortality. However, on multivariate analysis, only older age, male sex, and low albumin levels were associated with higher mortality. Surprisingly, a subgroup analysis showed that females without NAFLD were at a higher risk of mortality than those with fatty liver (4.9% vs 12.3%; P=0.006). Similarly, patients with lower AST levels had higher mortality compared to patients with significantly elevated AST levels (more than two times the upper limit of normal (ULN)), irrespective of the presence of fatty liver. ConclusionsThe prevalence of fatty liver in severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) infected patients is similar to the general population in India, the presence of which is not a predictor of severe disease. However, mor...

show abstract

Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effect of Nonalcoholic Fatty Liver Disease (NAFLD) on COVID-19: A Single-Center Study of 3983 Patients With Review of Literature

Nath¹,

Kumar²,

Mallick³

et al. 2022

Cureus

View full text Add to dashboard Cite

show abstract

“…However, a single-center study from India reported a nonsignificant difference in hospital stay and mortality in COVID-19 patients with or without NAFLD[ 64 ]. Similarly, Madan et al [ 65 ] also documented no association of fatty liver with COVID-19 morbidity and mortality.…”

Section: Chronic Liver Diseasementioning

confidence: 99%

Hepatic manifestations of coronavirus disease 2019 infection: Clinical and laboratory perspective

Hanif¹,

Majid²,

Ahmed³

et al. 2022

World J Virol

View full text Add to dashboard Cite

The novel coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2, has become a global challenge of unprecedented nature since December 2019. Although most patients with COVID-19 exhibit mild clinical manifestations and upper respiratory tract involvement, in approximately 5%-10% of patients, the disease is severe and involves multiple organs, leading to multi-organ dysfunction and failure. The liver and gastrointestinal tract are also frequently involved in COVID-19. In the context of liver involvement in patients with COVID-19, many key aspects need to be addressed in both native and transplanted organs. This review focuses on the clinical presentations and laboratory abnormalities of liver function tests in patients with COVID-19 with no prior liver disease, patients with pre-existing liver diseases and liver transplant recipients. A brief overview of the history of COVID-19 and etiopathogenesis of the liver injury will also be described as a prelude to better understanding the above aspects.

show abstract

Comparison of liver fibrosis scores and fatty liver on computed tomography as risk factors for severity of COVID‐19

Kamiya,

Shinoda,

Ishii

et al. 2024

JGH Open

View full text Add to dashboard Cite

Background and AimIncreased liver fibrosis scores (LFS), such as fibrosis‐4 index (FIB‐4) or non‐alcoholic fatty liver disease fibrosis score (NFS), and fatty liver are known risk factors for severe coronavirus disease 2019 (COVID‐19). The purpose of this study was to identify the best scores, which predict the prognosis of COVID‐19.MethodsParticipants comprised consecutive Japanese COVID‐19 patients admitted to our hospital between February 14, 2020, and April 14, 2021. Multivariate logistic regression analysis was performed to evaluate the relationships between LFS (FIB‐4, NFS, aspartate aminotransferase‐to‐platelet ratio index [APRI], BARD score, and hepatic steatosis index [HSI]) or fatty liver on computed tomography (CT), and severity of COVID‐19.ResultsOf the 415 patients (mean age, 59 years), 177 patients (42.7%) needed oxygen therapy, 90 patients (21.7%) worsened to severe COVID‐19, and 45 patients (10.8%) died during admission. Multivariate logistic regression analysis showed that increased FIB‐4 and NFS were risk factors for death, severe COVID‐19, and oxygen demand; that increased BARD was a risk factor for severe COVID‐19 and oxygen demand; and that increased APRI and HSI were not risk factors for any status of COVID‐19. Furthermore, increased NFS or BARD and fatty liver were independent risk factors for severe COVID‐19 and oxygen demand.ConclusionsThis study showed that FIB‐4 and NFS were the best liver fibrosis scores that predicted worse prognosis for COVID‐19, and that increased NFS or BARD and fatty liver evident on CT represented independent risk factors for severe COVID‐19 and oxygen demand.

show abstract

Is Fatty Liver Associated with Increased Mortality and Morbidity in Coronavirus Disease 2019 (COVID-19) Pneumonia?

Cited by 15 publications

References 32 publications

Effect of Nonalcoholic Fatty Liver Disease (NAFLD) on COVID-19: A Single-Center Study of 3983 Patients With Review of Literature

Effect of Nonalcoholic Fatty Liver Disease (NAFLD) on COVID-19: A Single-Center Study of 3983 Patients With Review of Literature

Hepatic manifestations of coronavirus disease 2019 infection: Clinical and laboratory perspective

Comparison of liver fibrosis scores and fatty liver on computed tomography as risk factors for severity of COVID‐19

Contact Info

Product

Resources

About