Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. May 9, 2021; 10(3): 47-57
Published online May 9, 2021. doi: 10.5492/wjccm.v10.i3.47
Frequency of hepatic steatosis and its association with the pneumonia severity score on chest computed tomography in adult COVID-19 patients
Mehmet Tahtabasi, Tugrul Hosbul, Ergin Karaman, Yasin Akin, Nihat Kilicaslan, Mehmet Gezer, Fatih Sahiner
Mehmet Tahtabasi, Ergin Karaman, Yasin Akin, Nihat Kilicaslan, Mehmet Gezer, Department of Radiology, University of Health Science, Mehmet Akif Inan Education and Research Hospital, Sanliurfa 63000, Turkey
Tugrul Hosbul, Fatih Sahiner, Department of Medical Microbiology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06100, Turkey
Author contributions: Tahtabasi M contributed to the study design, concept, writing the manuscript, and revising the final version; Karaman E contributed to data collection and manuscript revision; Sahiner F contributed to writing and discussion management; Akin Y contributed to data management and manuscript revision, data collection, interpretation of data, and revising of the manuscript; Kilicaslan N contributed to data collection and revision; Gezer M contributed to data collection; Hosbul T contributed to critical revision; All authors read and approved the final manuscript.
Institutional review board statement: This research was approved by the Clinical Research Ethics Committee of Harran University (date: 07.12.2020 and session: 20).
Informed consent statement: The study was retrospective in nature and no specific intervention is described in this article. The medical research center waived informed consent for this study.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The authors agree to share data if it is permitted by their institution.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mehmet Tahtabasi, MD, Associate Professor, Department of Radiology, University of Health Science, Mehmet Akif Inan Education and Research Hospital, Ertugrul Gazi street, Karakopru, Sanliurfa 63000, Turkey. mehmet.tahtabasi@sbu.edu.tr
Received: January 19, 2021
Peer-review started: January 19, 2021
First decision: February 15, 2021
Revised: February 19, 2021
Accepted: April 22, 2021
Article in press: April 22, 2021
Published online: May 9, 2021
Processing time: 108 Days and 17 Hours
Abstract
BACKGROUND

Recent studies of the coronavirus disease 2019 (COVID-19) demonstrated that obesity is significantly associated with increased disease severity, clinical outcome, and mortality. The association between hepatic steatosis, which frequently accompanies obesity, and the pneumonia severity score (PSS) evaluated on computed tomography (CT), and the prevalence of steatosis in patients with COVID-19 remains to be elucidated.

AIM

To assess the frequency of hepatic steatosis in the chest CT of COVID-19 patients and its association with the PSS.

METHODS

The chest CT images of 485 patients who were admitted to the emergency department with suspected COVID-19 were retrospectively evaluated. The patients were divided into two groups as COVID-19-positive [CT- and reverse transcriptase-polymerase chain reaction (RT-PCR)-positive] and controls (CT- and RT-PCR-negative). The CT images of both groups were evaluated for PSS as the ratio of the volume of involved lung parenchyma to the total lung volume. Hepatic steatosis was defined as a liver attenuation value of ≤ 40 Hounsfield units (HU).

RESULTS

Of the 485 patients, 56.5% (n = 274) were defined as the COVID-19-positive group and 43.5% (n = 211) as the control group. The average age of the COVID-19-positive group was significantly higher than that of the control group (50.9 ± 10.9 years vs 40.4 ± 12.3 years, P < 0.001). The frequency of hepatic steatosis in the positive group was significantly higher compared with the control group (40.9% vs 19.4%, P < 0.001). The average hepatic attenuation values were significantly lower in the positive group compared with the control group (45.7 ± 11.4 HU vs 53.9 ± 15.9 HU, P < 0.001). Logistic regression analysis showed that after adjusting for age, hypertension, diabetes mellitus, overweight, and obesity there was almost a 2.2 times greater odds of hepatic steatosis in the COVID-19-positive group than in the controls (odds ratio 2.187; 95% confidence interval: 1.336-3.580, P < 0.001).

CONCLUSION

The prevalence of hepatic steatosis was significantly higher in COVID-19 patients compared with controls after adjustment for age and comorbidities. This finding can be easily assessed on chest CT images.

Keywords: Liver; Steatosis; COVID-19; Computed tomography; Pneumonia severity score

Core Tip: We evaluated the frequency of hepatic steatosis in the computed tomography (CT) of coronavirus disease 2019 (COVID-19) patients and its association with the pneumonia severity score (PSS). We retrospective evaluated the CTs of 485 patients with suspected COVID-19. Regression analysis showed that after adjusting for age and comorbidities there was almost a 2.2 times greater odds of hepatic steatosis in the COVID-19-positive group than in controls (odds ratio 2.187; 95% confidence interval: 1.336-3.580, P < 0.001). There was a positive correlation between hepatic steatosis and PSS. The study revealed a significantly higher prevalence of hepatic steatosis on CT in COVID-19 patients compared with controls.