HEPATIC STEATOSIS MAY LEAD TO WORSE OUTCOMES IN PATIENTS WITH LIVER INJURY AND COVID-19

ABSTRACT

INTRODUCTION: Patients with coronavirus disease (COVID -19) and comorbid conditions such as obesity and diabetes are known to have worse disease outcomes. Metabolic syndrome is considered a major risk factor for both fatty liver and COVID-19. Patients with coronavirus may have transaminitis and fatty liver could exacerbate the SARS-CoV-2 cytokine storm. Our study aims to assess the association between the presence of fatty liver on outcomes of COVID-19 infection with acute liver injury. Methods: We conducted a retrospective observational study between March to June 2020. All hospitalized adults with a positive SARS CoV-2 PCR and an abdominal ultrasound (USG) performed during the index admission were included. The indication of the USG was for the evaluation of transaminitis. We extracted demographic data, laboratory parameters, and imaging studies from the electronic medical record. We also reviewed for sonographic features indicative of portal hypertension. We compared COVID-19 patients with and without fatty liver on USG of the abdomen. Results: There were a total of 29 COVID-19 positive patients from which 17 (58%) had fatty liver. There were no significant differences observed between the two groups in terms of demographics, comorbidities, and initial laboratory parameters except ferritin level (1105 vs 600, p = 0.0379) (Table 1). There were no significant differences with regards to other related serological markers (e.g. CRP, LDH, d-dimer). Both groups were comparable for sonographic signs of portal hypertension. A notable proportion of patients in the fatty liver group required mechanical ventilation during their hospital course (47% vs 16.7%, p = 0.1261) and had increased mortality (41.2% vs 16.7%. p = 0.2341) but these findings did not reach statistical significance. There was no difference in the length of stay between both groups. On multivariate analysis (Table 2), there was no association between fatty liver and mortality. Conclusion: We observed that COVID-19 patients with fatty liver disease are prone to worse outcomes, and this is likely independent of underlying metabolic syndrome. Preliminary results of our study did not meet statistical significance, however, data trajectory suggests a possible association that could yield significance as more patients are recruited and the study power increases. Furthermore, ferritin is a marker of immune dysregulation and an acute phase reactant, known to be elevated in severe COVID-19. Hyperferritinemia in our cohort of patients with fatty liver disease further validates a severe COVID-19 course compared to those without fatty liver disease. (Table presented.)