Can Opportunistic Use of Computed Tomography Help Reveal the Association Between Hepatic Steatosis and Disease Severity in Hospitalized COVID-19 Patients?

Abstract

Purpose

To measure hepatic steatosis (HS) in hospitalized COVID-19 patients using unenhanced chest computed tomography (CT) imaging and to evaluate the relationship between disease severity and prognosis in adult patients.

Materials and Methods

This retrospective study included 152 consecutive hospitalized COVID-19 patients with a positive reverse transcriptase polymerase chain reaction (RT-PCR) test. The COVID-19 Reporting and Data System (CO-RADS) and the chest CT score were evaluated. HS measurements were performed based on CT images using a single region of interest placed on the right liver lobe (segments V-VII). HS was defined as a liver attenuation value <40 Hounsfield units. Data were collected and compared with the patients’ prognostic parameters.

Results

Of the 152 inpatients, 137 patients (90.1%) had a CT score ≥3 and 109 patients (71.7%) had a CO-RADS score ≥4, 43 (28.2%) had HS. All patients with HS (100%) and 94/109 (86.2%) patients without HS had a CT score ≥3. There was a statistically significant difference between the two groups in terms of chest CT score (p=0.006). There was no statistically significant difference between the two groups in terms of CO-RADS score (p=0.291). The median CRP levels were significantly increased in patients with HS compared to patients without HS (p=0.023). There was no significant difference in ICU hospitalization and mortality due to the presence of HS (p>0.05).

Conclusion

The current study revealed significantly higher chest CT scores in COVID-19 patients with HS measured on CT compared to those without HS. Opportunistic use of CT images for the detection of HS can be considered as an adjunctive tool in the risk analysis of COVID-19 patients hospitalized due to COVID-19 pneumonia.

Key Points

The severity of COVID-19 disease is increased in hospitalized patients with hepatosteatosis compared to patients with a normal liver. Density measurements for the evaluation of HS using opportunistic CT applications can be considered as an adjunctive tool in the prognostic evaluation of hospitalized patients with COVID-19 pneumonia.

Citation Format

• Parlak AE, Erdem Toslak İ, Turkoglu Selcuk N. Can Opportunistic Use of Computed Tomography Help Reveal the Association Between Hepatic Steatosis and Disease Severity in Hospitalized COVID-19 Patients?. Rofo 2025; 197: 648–656

Zusammenfassung

Ziel

Messung der Lebersteatose (HS) bei hospitalisierten COVID-19-Patienten mittels nativer Thorax-Computertomografie (CT) und Bewertung des Zusammenhangs zwischen Schweregrad der Erkrankung und Prognose bei erwachsenen Patienten.

Material und Methoden

Diese retrospektive Studie umfasste 152 aufeinanderfolgende hospitalisierte COVID-19-Patienten mit einem positiven RT-PCR-Test (Reverse Transkriptase-Polymerase-Kettenreaktion). Das COVID-19 Reporting and Data System (CO-RADS) und der Thorax-CT-Score wurden ausgewertet. Die Messungen für HS wurden anhand von CT-Bildern mit einer einzigen Region of Interest durchgeführt, die auf dem rechten Leberlappen (Segmente V-VII) platziert wurde. HS wurde bei Leberdichtewerten von <40 Hounsfield-Einheiten definiert. Die so erhobenen Daten wurden mit den prognostischen Parametern der Patienten verglichen.

Ergebnisse

Von den insgesamt 152 stationären Patienten hatten 137 Patienten (90,1%) einen CT-Score ≥3 und 109 Patienten (71,7%) einen CO-RADS-Score ≥4, 43 (28,2%) eine HS. Alle Patienten mit HS (100%) und 94/109 (86,2%) der Patienten ohne HS hatten einen CT-Score ≥3. Es gab statistisch signifikante Unterschiede zwischen zwei Gruppen in Bezug auf den Thorax-CT-Score (p = 0,006). Es gab keinen statistisch signifikanten Unterschied zwischen zwei Gruppen in Bezug auf den CO-RADS-Score (p = 0,291). Die medianen CRP-Spiegel waren bei Patienten mit HS im Vergleich zu Patienten ohne HS signifikant erhöht (p = 0,023). Es gab keinen signifikanten Unterschied zwischen Krankenhausaufenthalten auf der Intensivstation und der Mortalität durch das Vorhandensein von einer HS (p>0,05).

Schlussfolgerung

Die aktuelle Studie ergab signifikant höhere Thorax-CT-Scores bei COVID-19-Patienten mit HS, die im CT gemessen wurden, im Vergleich zu Patienten ohne HS. Die opportunistische Verwendung von CT-Bildern zur Erkennung von HS kann als zusätzliches Instrument bei der Risikoanalyse von COVID-19-Patienten angesehen werden, die aufgrund einer COVID-19-Lungenentzündung ins Krankenhaus eingeliefert wurden.

Kernaussagen

Der Schweregrad der COVID-19-Erkrankung ist bei hospitalisierten Patienten mit Hepatosteatose im Vergleich zu Patienten mit normaler Leber erhöht. Dichtemessungen zur Bewertung von HS mit opportunistischen CT-Anwendungen können als ergänzendes Instrument bei der prognostischen Bewertung der hospitalisierten Patienten mit COVID-19-Lungenentzündung betrachtet werden.

Keywords

computed tomography - hepatosteatosis - lung - liver - COVID-19 - CO-RADS

Publication History

Received: 04 June 2024

Accepted after revision: 08 July 2024

Article published online:
21 August 2024

• References

• 1 Tahtabasi M, Hosbul T, Karaman E. et al. Frequency of hepatic steatosis and its association with the pneumonia severity score on chest computed tomography in adult COVID-19 patients. World J Crit Care Med 2021; 10 (03) 47-57
• 2 Lavie CJ, Sanchis-Gomar F, Henry BM. et al. COVID-19 and obesity: links and risks. Expert Rev Endocrinol Metab 2020; 15 (04) 215-216
• 3 Medeiros AK, Barbisan CC, Cruz IR. et al. Higher frequency of hepatic steatosis at CT among COVID-19-positive patients. Abdom Radiol (NY) 2020; 45 (09) 2748-2754
• 4 Jawahar A, Gonzalez B, Balasubramanian N. et al. Comparison of correlations between lipid profile and different computed tomography fatty liver criteria in the setting of incidentally noted fatty liver on computed tomography examinations. Eur J Gastroenterol Hepatol 2017; 29 (12) 1389-1396
• 5 Palomar-Lever A, Barraza G, Galicia-Alba J. et al. Hepatic steatosis as an independent risk factor for severe disease in patients with COVID-19: A computed tomography study. JGH Open 2020; 4 (06) 1102-1107
• 6 Starekova J, Hernando D, Pickhardt PJ. et al. Quantification of Liver Fat Content with CT and MRI: State of the Art. Radiology 2021; 301 (02) 250-262
• 7 Francone M, Iafrate F, Masci GM. et al. Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis. Eur Radiol 2020; 30 (12) 6808-6817
• 8 Elmokadem AH, Mounir AM, Ramadan ZA. et al. Comparison of chest CT severity scoring systems for COVID-19. Eur Radiol 2022; 32 (05) 3501-3512
• 9 Özel M, Aslan A, Araç S. Use of the COVID-19 Reporting and Data System (CO-RADS) classification and chest computed tomography involvement score (CT-IS) in COVID-19 pneumonia. Radiol Med 2021; 126 (05) 679-687
• 10 Izcovich A, Ragusa MA, Tortosa F. et al. Prognostic factors for severity and mortality in patients infected with COVID-19: A systematic review. PLoS One 2020; 15 (11) e0241955
• 11 Hansell DM, Bankier AA, MacMahon H. et al. Fleischner Society: glossary of terms for thoracic imaging. Radiology 2008; 246 (03) 697-722
• 12 Vermani S, Kaushal A, Kaushal J. COVID-19 and the Radiology Department: What We Know So Far. SN Compr Clin Med 2020; 2 (11) 1998-2004
• 13 Simpson S, Kay FU, Abbara S. et al. Radiological Society of North America Expert Consensus Document on Reporting Chest CT Findings Related to COVID-19: Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA. Radiol Cardiothorac Imaging 2020; 2 (02) e200152
• 14 Prokop M, van Everdingen W, van Rees Vellinga T. et al. COVID-19 Standardized Reporting Working Group of the Dutch Radiological Society. CO-RADS: A Categorical CT Assessment Scheme for Patients Suspected of Having COVID-19-Definition and Evaluation. Radiology 2020; 296 (20) E97-E104
• 15 Doğan H, Uzer E, Esengür ÖT. et al. Relationship between hepatic and pancreatic steatosis and the COVID-19 pneumonia total severity score and prognosis with an emphasis on prognostic strength. Diagn Interv Radiol 2023; 29 (04) 363-370
• 16 Çoraplı M, Çil E, Oktay C. et al. Role of hepatosteatosis in the prognosis of COVID 19 disease. Clin Imaging 2021; 80: 1-5
• 17 Villard O, Morquin D, Molinari N. et al. The Plasmatic Aldosterone and C-Reactive Protein Levels, and the Severity of Covid-19: The Dyhor-19 Study. J Clin Med 2020; 9 (07) 2315
• 18 Yang M, Chen X, Xu Y. A Retrospective Study of the C-Reactive Protein to Lymphocyte Ratio and Disease Severity in 108 Patients with Early COVID-19 Pneumonia from January to March 2020 in Wuhan, China. Med Sci Monit 2020; 26: e926393
• 19 Ahnach M, Zbiri S, Nejjari S. et al. C-reactive protein as an early predictor of COVID-19 severity. J Med Biochem 2020; 39 (04) 500-507
• 20 Parlak S, Çıvgın E, Beşler MS. et al. The effect of hepatic steatosis on COVID-19 severity: Chest computed tomography findings. Saudi J Gastroenterol 2021; 27 (02) 105-110
• 21 Ji D, Qin E, Xu J. et al. Non-alcoholic fatty liver diseases in patients with COVID-19: A retrospective study. J Hepatol 2020; 73 (02) 451-453
• 22 Lieveld AWE, Azijli K, Teunissen BP. et al. Chest CT in COVID-19 at the ED: Validation of the COVID-19 Reporting and Data System (CO-RADS) and CT Severity Score: A Prospective, Multicenter, Observational Study. Chest 2021; 159 (03) 1126-1135