Association of Liver Steatosis with Clinical Outcomes in SARS-CoV-2 (COVID-19) Infected Patients

Background: Corona virus disease 2019 (COVID-19) caused by severe acute respiratorySyndrome corona virus-2(SARS-CoV-2)is a global pandemic, affectingall populations across the planet. Early studies havesuggestedthatpresence of metabolic syndrome is associated with increased disease severity in these patients. Non-alcoholic fatty liver disease (NAFLD)associated with metabolic syndromehas a prevalence of 9%-32% in India and maybe related to increased morbidity and mortality in COVID-19, but has not been demonstrated so far. Aim: To assess the presence of liver fat as a surrogate marker to predict disease severity and outcome of SARS-CoV-2 infection. Methods: Total 6003 patients with RT-PCR-confirmed COVID-19 infection admitted to KIMS hospital, Bhubaneswar, India from 4th April 2020 to 31st December 2020 were included in the study.Patients whounderwent non-contrast CT(NCCT) chest wereevaluated for presence of hepaticsteatosis based on a validated criterion(liver attenuation (HU) value at least 10 HU lower than spleen, absolute liver attenuation lower than 40 HU and L/S HU ratio <1).Patients were divided into two groups, with or without fatty liver.Baseline characteristics including age, sex, liver function test, duration of hospital stay and outcomes were compared. Results: Of 6003 patients, 4083 underwent NCCT and assessed for presence of fatty liver. Mean age was 51 ±16.44 years. The majority of patients were male (75.5%). Of 4083 patients,819 (20%) had fatty liver. Mean HU of liver and spleen in patients with fatty liver were 38.31±11.16 SD and 58.39 ±7.22 SD respectively. L/S ratio < 1 was seen in 33% patients. Mean CT severity were (fatty liver-15.3 ± 5.8 SD and non-fatty liver-13.5 ± 6.8 SD. P=-<0.05). Overall mortality was 6%.Mortality rate among patients with fatty liver was 6.96% while in patients without fatty liver was 5.76% (P = 0.196).Mean duration of hospitalization were (fatty liver-9.98 days, non-fatty liver-10.64 days;P=0.66).Fatty liver in survivors and non-survivors were19.85% and 23.27% (P=0.196)respectively. Conclusions: The prevalence of fatty liver in SARS CoV-19 (COVID 19) patients is similar to general population, the presence of which is not a predictor of severe disease.