ABSTRACT
Background: Fatty liver has been shown to be associated with severe COVID-19 disease without any impact on mortality. This is based on heterogenous criteria for defining both fatty liver as well as the severity parameters. This study aimed to study the impact of fatty liver on the mortality and severity of disease in patients with COVID-19 pneumonia. Methods: In a case control study design, patients with COVID-19 pneumonia (COVID-19 computed tomography severity index [CTSI] on high-resolution computed tomography chest of ≥1) with fatty liver (defined as liver to spleen attenuation index ≤5 on noncontrast computed tomography cuts of upper abdomen) were compared with those without fatty liver. The primary outcome measure was in-hospital mortality, and the secondary outcome measures were CTSI score, need for intensive care unit (ICU) care, need for ventilatory support, duration of ICU stay, and duration of hospital stay. Results: Of 446 patients with COVID-19 pneumonia, 289 (64.7%)admitted to Max Hospital, Saket, India, between January 1, 2021, and October 30, 2021, had fatty liver. Fifty-nine of 446 patients died during the index admission. In-hospital mortality was not different between patients with fatty liver (38 [13.24%]) or without fatty liver (21 [13.81%]). COVID-19 CTSI score was found to be significantly higher among patients who had fatty liver (13.40 [5.16] vs 11.81 [5.50]; P = 0.003). There was no difference in the requirement of ICU (94 [32%] vs 62 [39.49%]; P = 0.752), requirement of ventilatory support (27 [9.34%] vs 14 [8.91%]; P = 0.385), duration of ICU stay (8.29 [6.87] vs 7.07 [5.71] days; P = 0.208), and duration of hospital stay (10.10 [7.14] vs 10.69 [8.13] days; P = 0.430) between the groups with fatty liver or no fatty liver. Similarly, no difference was found in primary or secondary outcomes measure between the group with severe fatty liver vs mild/moderate or no fatty liver. High total leucocyte count and Fibrosis-4 (FIB-4) index were independently associated with mortality. Conclusions: Fatty liver may not be associated with increased mortality or clinical morbidity in patients who have COVID-19 pneumonia.
ABSTRACT
PURPOSE: To determine whether the percentage of lung involvement at the initial chest computed tomography (CT) is related to the subsequent risk of in-hospital death in patients with coronavirus disease-2019 (Covid-19). MATERIALS AND METHODS: Using a cohort of 154 laboratory-confirmed Covid-19 pneumonia cases that underwent chest CT between February and April 2020, we performed a volumetric analysis of the lung opacities. The impact of relative lung involvement on outcomes was evaluated using multivariate logistic regression. The primary endpoint was the in-hospital mortality rate. The secondary endpoint was major adverse hospitalization events (intensive care unit admission, use of mechanical ventilation, or death). RESULTS: The median age of the patients was 65 years: 50.6 % were male, and 36.4 % had a history of smoking. The median relative lung involvement was 28.8 % (interquartile range 9.5-50.3). The overall in-hospital mortality rate was 16.2 %. Thirty-six (26.3 %) patients were intubated. After adjusting for significant clinical factors, there was a 3.6 % increase in the chance of in-hospital mortality (OR 1.036; 95 % confidence interval, 1.010-1.063; Pâ¯=â¯0.007) and a 2.5 % increase in major adverse hospital events (OR 1.025; 95 % confidence interval, 1.009-1.042; Pâ¯=â¯0.002) per percentage unit of lung involvement. Advanced age (Pâ¯=â¯0.013), DNR/DNI status at admission (Pâ¯<â¯0.001) and smoking (Pâ¯=â¯0.008) also increased in-hospital mortality. Older (Pâ¯=â¯0.032) and male patients (Pâ¯=â¯0.026) had an increased probability of major adverse hospitalization events. CONCLUSIONS: Among patients hospitalized with Covid-19, more lung consolidation on chest CT increases the risk of in-hospital death, independently of confounding clinical factors.