NAFLD determined by Dallas Steatosis Index is associated with poor outcomes in COVID-19 pneumonia: a cohort study

Abstract

Coronavirus disease 2019 is a worldwide health challenge. Liver steatosis diagnosis based on imaging studies has been implicated in poor outcomes of COVID-19 pneumonia, but results are inconsistent. The Dallas Steatosis Index (DSI) is an available calculator developed to identify patients with non-alcoholic fatty liver disease (NAFLD). We hypothesized that it would be associated with in-hospital mortality, intensive care unit admission (ICU), and invasive mechanical ventilation (IMV). We conducted a retrospective cohort study on inpatients with confirmed COVID-19 pneumonia between February 26 and April 11, 2020. We computed the DSI on admission, and patients with high DSI were considered with NAFLD. We employed logistic regression to study the association between NAFLD, mortality, ICU admission, and IMV. We studied the association between liver steatosis on computed tomography (CT) and these outcomes, and also between Metabolic Associated Fatty Liver Disease (MAFLD) based on CT findings and risk factors and the outcomes. 470 patients were included; 359 had NAFLD according to the DSI. They had a higher frequency of type 2 diabetes (31% vs 14%, p < 0.001), obesity (58% vs 14%, p < 0.001), and arterial hypertension (34% vs 22%, p = 0.02). In univariable analysis, NAFLD was associated with mortality, ICU admission, and IMV. Liver steatosis by CT and MAFLD were not associated with any of these outcomes. In multivariable logistic regression, high DSI remained significantly associated with IMV and death. High DSI, which can be easily computed on admission, was associated with IMV and death, and its use to better stratify the prognosis of these patients should be explored. On the other hand, liver steatosis by CT and MAFLD were not associated with poor outcomes.

Sarcopenia is associated with mortality in patients with COVID-19 independent of other demographic risk factors

“…There are a few studies that investigated the relationship between sarcopenia and adverse end-points of COVID-19 [13][14][15]. Kim et al [13] investigated prognostic effects of sarcopenia in patients with COVID-19 patients.…”

“…They asserted that sarcopenia assessed by chest CT at T12 level was an independent predictor for delayed hospital discharge but not for mortality. Moctezuma-Velázquez et al [14] also studthe relationship between sarcopenia and negative outcomes in patients with COVID-19. They reported that sarcopenia was not related to in-hospital mortality, need for intubation, and ICU admission.…”

“…These clinical problems are also firmly related with poor prognosis in patients with COVID-19 [2][3][4]. In the literature, there are a few studies with conflicting results regarding the impact of sarcopenia on adverse outcomes in patients with COVID-19 [13][14][15]. Moreover, there are no standardized values for the evaluation of sarcopenia in this population.…”

“…1). Then, CSA measurements were normalized to patient size by dividing CSA with height in square meters to provide the skeletal muscle index (T12-SMI; cm2 /m2) [13,14].…”

Coronavirus Disease 2019 Vaccinations in Patients With Chronic Liver Disease and Liver Transplant Recipients: An Update

“…There have been some studies evaluating the role of this particular liver disease in COVID-19 patients. Moctezuma-Velázquez et al reported that NAFLD is the independent factor associated with the requirement of invasive mechanical ventilator and mortality in COVID-19 patients ( 26 ). Subsequently, the association between NAFLD or MAFLD and the increase COVID-19 severity has been confirmed by two meta-analyses ( 27 , 28 ) ( Figure 1 ).…”