Hepatic Steatosis Is Associated with Increased Disease Severity and Liver Injury in Coronavirus Disease-19
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ORIGINAL ARTICLE
Hepatic Steatosis Is Associated with Increased Disease Severity and Liver Injury in Coronavirus Disease‑19 Vincent L. Chen1 · Fadi Hawa2 · Jeffrey A. Berinstein1 · Chanakyaram A. Reddy1 · Ihab Kassab3 · Kevin D. Platt1 · Chia‑Yang Hsu1 · Calen A. Steiner1 · Jeremy Louissaint1 · Naresh T. Gunaratnam4 · Pratima Sharma1 Received: 7 August 2020 / Accepted: 14 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
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 nonAsians) 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. Keywords SARS-CoV-2 · Acute liver injury · Outcomes · NAFLD Abbreviations ALT Alanine aminotransferase AST Aspartate aminotransferase BMI Body mass index COVID-19 Coronavirus disease-2019
HS Hepatic steatosis HSI Hepatic steatosis index IQR Interquartile range ULN Upper limit of normal WHO World Health Organization
* Vincent L. Chen [email protected]
Introduction
Pratima Sharma [email protected] 1
Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
2
Department of Medicine, St. Joseph Mercy Ann Arbor Hospital, Ypsilanti, MI, USA
3
Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
4
Huron Gastro Center for Digestive Disease, Ypsilanti, MI, USA
Coronavirus disease-2019 (COVID-19) is a pandemic responsible for > 25 million cases and > 800,000 deaths worldwide [1]. COVID-19 frequently results in gastrointestinal dise
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