Hepatic Steatosis Is Associated with Increased Disease Severity and Liver Injury in Coronavirus Disease-19

Abstract

Background Coronavirus disease-2019 (COVID-19) is a global pandemic. Obesity has been associated with increased disease severity in COVID-19, and obesity is strongly associated with hepatic steatosis (HS). However, how HS alters the natural history of COVID-19 is not well characterized, especially in Western populations. Aims To characterize the impact of HS on disease severity and liver injury in COVID-19. Methods We examined the association between HS and disease severity in a single-center cohort study of hospitalized COVID-19 patients at Michigan Medicine. HS was defined by either hepatic steatosis index > 36 (for Asians) or > 39 (for non-Asians) or liver imaging demonstrating steatosis > 30 days before onset of COVID-19. The primary predictor was HS. The primary outcomes were severity of cardiopulmonary disease, transaminitis, jaundice, and portal hypertensive complications. Results In a cohort of 342 patients, metabolic disease was highly prevalent including nearly 90% overweight. HS was associated with increased transaminitis and need for intubation, dialysis, and vasopressors. There was no association between HS and jaundice or portal hypertensive complications. In a sensitivity analysis including only patients with liver imaging > 30 days before onset of COVID-19, imaging evidence of hepatic steatosis remained associated with disease severity and risk of transaminitis. Conclusions HS was associated with increased disease severity and transaminitis in COVID-19. HS may be relevant in predicting risk of complications related to COVID-19.

WITHDRAWN: Dyslipidemia Increases the Risk of Severe COVID-19: A Systematic Review, Meta-analysis, and Meta-regression

“…Meanwhile, Santos et al reported that dyslipidemia as an independent predictor of mortality 19 . Obesity and chronic liver disease, including fatty liver disease, may affect the association between dyslipidemia and poor outcome; because both obesity and fatty liver disease are associated with poor prognosis 24 , 25 , 26 . However, meta-regression analysis was not possible because only three studies were reporting chronic liver disease, and one study reporting obesity.…”

Liver injury in the era of COVID-19

“…Another cohort study of 342 patients with COVID-19 revealed a relationship between hepatic steatosis and both transaminitis and increased disease severity. However, steatosis did not predispose to the development of clinically relevant liver insufficiency during the course of infection[ 75 ].…”

COVID-19 and the liver: an adverse outcome pathway perspective

“…In fact, elder ( Li et al, 2020a ; Yu et al, 2020 ) and male ( Feng et al, 2020 ; Kaushik et al, 2020 ) COVID-19 patients seem most prone to develop liver damage. Patients with pre-existing liver pathologies, in particular non-alcoholic steatohepatitis or metabolic-associated fatty liver disease, show higher liver injury in the course of the disease ( Chen et al, 2021 ; Gao et al, 2021 ; Pan et al, 2021 ), yet others were not able to establish a link between chronic liver disease and mortality/severity of COVID-19 ( Lippi et al, 2021 ; Palomar-Lever et al, 2020 ).…”