Hepatic steatosis as an independent risk factor for severe disease in patients with COVID‐19: A computed tomography study

Abstract

Background and Aim

Hepatic steatosis (HS) is associated with diabetes, hypertension, and obesity, comorbidities recently related to COVID‐19 severity. Here, we assessed if tomographic HS is also a risk factor for severe COVID‐19 pneumonia.

Methods

We included 213 patients with a positive real time polymerase chain reaction (RT‐PCR) test and chest computed tomography (CT) from an out‐hospital facility and a hospital. We obtained information on demographics; weight; height; smoking history; diabetes; hypertension; and cardiovascular, lung, and renal disease. Two radiologists scored the CO‐RADs system (COVID‐19 Reporting and Data System) (1 = normal, 2 = inconsistent, 3–4 = indeterminate, and 5 = typical findings) and the chest CT severity index (≥20 of 40 was considered severe disease). They evaluated the liver‐to‐spleen ratio (CT _L/S) and defined tomographic steatosis as a CT _L/S index ≤0.9. We used descriptive statistics, χ ² and t student tests, logistic regression, and reported odds ratio (OR) with 95% confidence interval (CI).

Results

Of the patients, 61% were men, with a mean age of 51.2 years, 48.3% were CO‐RADs 1 and 51.7% CO‐RADs 2–5. Severe tomographic disease was present in 103 patients (48.4%), all CO‐RADs 5. This group was older; mostly men; and with a higher prevalence of obesity, hypertension, diabetes, and HS (69.9 vs 29%). On multivariate analysis, age (OR 1.058, 95% CI 1.03–1.086, P < 0.0001), male gender (OR 1.9, 95% CI 1.03–3.8, P = 0.04), and HS (OR 4.9, 95% CI 2.4–9.7, P < 0.0001) remained associated.

Conclusion

HS was independently associated with severe COVID pneumonia. The physiopathological explanation of this finding remains to be elucidated. CT _L/S should be routinely measured in thoracic CT scans in patients with COVID‐19 pneumonia.

Abstract

Hepatic steatosis is an independent risk factor for chest computed tomography ?(CT)?severe ?COVID‐19? infection (odds ratio 4.9, 95% confidence interval 2.4–?9.7, P < 0.0001). Liver CT density should be measured and reported in all chest CT scans in patients with ?COVID‐19? pneumonia.