Hepatic Steatosis Is Associated with Increased Disease Severity and Liver Injury in Coronavirus Disease-19

Vincent L. Chen, Fadi Hawa, Jeffrey A. Berinstein, Chanakyaram A. Reddy, Ihab Kassab, Kevin D. Platt, Chia Yang Hsu, Calen A. Steiner, Jeremy Louissaint, Naresh T. Gunaratnam, Pratima Sharma

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Background: Coronavirus disease-2019 (COVID-19) is a global pandemic. Obesity has been associated with increased disease severity in COVID-19, and obesity is strongly associated with hepatic steatosis (HS). However, how HS alters the natural history of COVID-19 is not well characterized, especially in Western populations. Aims: To characterize the impact of HS on disease severity and liver injury in COVID-19. Methods: We examined the association between HS and disease severity in a single-center cohort study of hospitalized COVID-19 patients at Michigan Medicine. HS was defined by either hepatic steatosis index > 36 (for Asians) or > 39 (for non-Asians) or liver imaging demonstrating steatosis > 30 days before onset of COVID-19. The primary predictor was HS. The primary outcomes were severity of cardiopulmonary disease, transaminitis, jaundice, and portal hypertensive complications. Results: In a cohort of 342 patients, metabolic disease was highly prevalent including nearly 90% overweight. HS was associated with increased transaminitis and need for intubation, dialysis, and vasopressors. There was no association between HS and jaundice or portal hypertensive complications. In a sensitivity analysis including only patients with liver imaging > 30 days before onset of COVID-19, imaging evidence of hepatic steatosis remained associated with disease severity and risk of transaminitis. Conclusions: HS was associated with increased disease severity and transaminitis in COVID-19. HS may be relevant in predicting risk of complications related to COVID-19.

Original languageEnglish (US)
Pages (from-to)3192-3198
Number of pages7
JournalDigestive Diseases and Sciences
Issue number9
StatePublished - Sep 2021
Externally publishedYes


  • Acute liver injury
  • Outcomes
  • SARS-CoV-2

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology


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