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

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