Abstract
Background: The objective of our study was to investigate the location, extension and type of novel coronavirus-induced disease 2019 (COVID-19) infection involvement and hepatic steatosis on initial chest computed tomography (CT). The relationship between fatty liver and severity of the disease was also investigated by measuring the liver attenuation index (LAI).
Methods: This study evaluated the chest CT images of 343 patients (201 male, mean age 48.43 years) who were confirmed to have COVID-19, using nasopharyngeal swab. The chest CTs were analyzed for laterality, number of involved lobes, diffuseness, number of lesions, and lesion types. The CT attenuation values of liver and spleen were measured, and LAI was calculated for the detection of hepatic steatosis. Univariate and multivariate logistic regression analysis were used to identify the independent early predictors for severe COVID-19.
Results: There was no significant difference between genders in terms of clinical course. Liver density and LAI were significantly lower in the intensive care unit (ICU) patients. The prevalence of severe disease was higher in the patients with hepatic steatosis than in the non-steatotic group (odds ratio [OR] 3.815, 95% confidence interval [CI] 1.97-7.37, P < 0.001). After adjusting for age and comorbidities including hypertension, diabetes mellitus, coronary artery disease, chronic obstructive pulmonary disease, and chronic kidney disease, multivariate logistic regression analysis showed that non-alcoholic fatty liver disease (NAFLD) was an independent risk factor for COVID-19 severity (OR 3.935, 95% CI 1.77-8.70, P = 0.001). The optimal cut-off value for LAI was calculated as 0.5 for predicting patients who required ICU treatment.
Conclusions: On the initial chest CT images of COVID-19 patients, presence of fatty liver is a strong predictor for severe disease.
Keywords: COVID-19; Computed tomography; hepatic steatosis; liver.
【저자키워드】 COVID-19, Computed tomography, liver, hepatic steatosis, 【초록키워드】 intensive care, severe COVID-19, severity, Infection, Comorbidities, Diabetes Mellitus, intensive care unit, COVID-19 severity, Comorbidity, Gender, Chronic kidney disease, diabetes, hypertension, ICU, Coronary artery disease, Prevalence, Computed tomography, Chest computed tomography, Nasopharyngeal swab, Clinical course, Chest CT, Non-alcoholic fatty liver disease, male, Patient, Kidney disease, age, location, Fatty liver, predictor, disease, liver, patients, spleen, COVID-19 patients, pulmonary disease, Analysis, chronic obstructive pulmonary disease, Odds ratio, severe disease, hepatic steatosis, Chest CT images, NAFLD, obstructive pulmonary disease, Coronary artery, fatty liver disease, Logistic regression analysis, 95% CI, no significant difference, 95% confidence interval, ICU treatment, lesions, multivariate logistic regression, cut-off value, independent risk factor, multivariate logistic regression analysis, lobes, extension, genders, steatosis, significantly lower, Chest CT image, independent, initial, laterality, analyzed, identify, involved, the patient, investigated, the disease, evaluated, required, calculated, were used, were measured, chronic obstructive, 【제목키워드】 Computed tomography,