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Hepatosteatozun COVID-19 Hastalarında Göğüs BT Şiddet Skorlarının Seyrine Etkisi

Year 2023, Volume: 33 Issue: 5, 491 - 496, 25.10.2023

Ahmet Turan Kaya Burcu Akman Veysel Kaya Şirin Çetin

https://doi.org/10.54005/geneltip.1274160

Abstract

Amaç: Literatürde pnömoni şiddetinin bir göstergesi olan BT şiddet skoru (BT-ŞS) değerlerinin, ardışık BT' lerde hepatosteatoz varlığına göre zamansal değişimi değerlendirilmemiştir. COVID-19 hastalarında, hepatosteatozun BT-ŞS' nin geçici değişimi üzerindeki etkisini araştırmayı amaçladık.
Materyal ve Metotlar: Retrospektif çalışmamıza Aralık 2021 ile Ocak 2022 tarihleri arasında hastanemize başvuran 472 RT-PCR pozitif COVID-19 hastası ( ≥ 18 yaş) dâhil edildi. Akciğerin her lobuna 0 ile 5 arasında değişen toraks BT şiddet skorları atandı ve toplam BT-ŞS elde edildi. Kantitatif analiz için hepatik/dalak atenüasyon oranı <1 ise, hepatosteatoz tanımlandı. BT-ŞS değerlerinin hepatosteatoz varlığına göre zamansal değişimlerini değerlendirmek için Wilcoxon testi kullanıldı. p<0,05 istatistiksel olarak anlamlı kabul edildi.
Bulgular: Toplam 472 hastanın 255/472'si (%54) hepatosteatoz pozitifti. Hepatosteatoz sıklığı, erkek hastalarda anlamlı olarak yüksekti, 167/255 (%65,5) (p<0,001). Ortalama yaş 64.04±14.35 idi. Yoğun bakıma yatış ve hepatosteatoz grupları arasında anlamlı fark yoktu (p=0,269). Mortalite ile hepatosteatoz varlığı arasında anlamlı fark yoktu (p=0,429). Hepatosteatozlu hastalarda 1. ve 2. BT-ŞS arasında anlamlı artış vardı (p<0.001). İkinci CT-SS'deki artış hepatosteatozlu hastalarda hepatosteatozsuz hastalara göre daha yüksekti.
Sonuç: Hepatosteatoz, COVID-19 hastalarında pnömoni şiddetinin geçici değişiminde kötü prognozun bir göstergesi olabilir.

Keywords

COVID-19 Bilgisayarlı Tomografi şiddet skoru hepatosteatoz hepatik-dalak atenüasyon oranı

References

  • WHO. COVID-19 Weekly Epidemiological Update 35. World Heal Organ. 2020;(December):1–3.
  • Li K, Wu J, Wu F, Guo D, Chen L, Fang Z, et al. The clinical and chest CT features associated with severe and critical COVID-19 pneumonia. Invest Radiol. 2020;
  • Chang YC, Yu CJ, Chang SC, Galvin JR, Liu HM, Hsiao CH, et al. Pulmonary sequelae in convalescent patients after severe acute respiratory syndrome: Evaluation with thin-section CT. Radiology. 2005;236(3):1067–75.
  • Le MH, Devaki P, Ha NB, Jun DW, Te HS, Cheung RC, et al. Prevalence of non-Alcoholic fatty liver disease and risk factors for advanced fibrosis and mortality in the United States. PLoS One. 2017 Mar 1;12(3).
  • Palomar-Lever A, Barraza G, Galicia-Alba J, Echeverri-Bolaños M, Escarria-Panesso R, Padua-Barrios J, et al. Hepatic steatosis as an independent risk factor for severe disease in patients with COVID-19: A computed tomography study. Vol. 4, JGH Open. 2020. p. 1102–7.
  • Targher G, Mantovani A, Byrne CD, Wang X-B, Yan H-D, Sun Q-F, et al. Detrimental effects of metabolic dysfunction-associated fatty liver disease and increased neutrophil-to-lymphocyte ratio on severity of COVID-19. Diabetes Metab. 2020;46(6):505–7.
  • Medeiros AK, Barbisan CC, Cruz IR, de Araújo EM, Libânio BB, Albuquerque KS, et al. Higher frequency of hepatic steatosis at CT among COVID-19-positive patients. Abdom Radiol. 2020;45(9):2748–54.
  • Gao F, Zheng KI, Wang X, Yan H, Sun Q, Pan K, et al. Metabolic associated fatty liver disease increases coronavirus disease 2019 disease severity in nondiabetic patients. J Gastroenterol Hepatol. 2021;36(1):204–7.
  • Hamer OW, Aguirre DA, Casola G, Sirlin CB. Imaging features of perivascular fatty infiltration of the liver: initial observations. Radiology. 2005;237(1):159–69.
  • Limanond P, Raman SS, Lassman C, Sayre J, Ghobrial RM, Busuttil RW, et al. Macrovesicular hepatic steatosis in living related liver donors: correlation between CT and histologic findings. Radiology. 2004;230(1):276–80.
  • Iwasaki M, Takada Y, Hayashi M, Minamiguchi S, Haga H, Maetani Y, et al. Noninvasive evaluation of graft steatosis in living donor liver transplantation. Transplantation. 2004;78(10):1501–5.
  • Zeb I, Li D, Nasir K, Katz R, Larijani VN, Budoff MJ. Computed Tomography Scans in the Evaluation of Fatty Liver Disease in a Population Based Study. The Multi-Ethnic Study of Atherosclerosis. Acad Radiol. 2012;19(7):811–8.
  • Guler E, Unal NG, Cinkooglu A, Savas R, Kose T, Pullukcu H, et al. Correlation of liver-to-spleen ratio, lung CT scores, clinical, and laboratory findings of COVID-19 patients with two consecutive CT scans. Abdom Radiol. 2021;46(4):1543–51.
  • Tahtabasi M, Hosbul T, Karaman E, Akin Y, Kilicaslan N, Gezer M, 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(3):47–57.
  • Çoraplı M, Çil E, Oktay C, Kaçmaz H, Çoraplı G, Bulut HT. Role of hepatosteatosis in the prognosis of COVID 19 disease. Clin Imaging. 2021;80(February):1–5.
  • Pan F, Ye T, Sun P, Gui S, Liang B, Li L. Time Course of Lung Changes at Chest CT during Recovery. Radiology. 2020;295(3):715–21.
  • Piekarski J, Goldberg HI, Royal SA, Axel L, Moss AA. Difference between liver and spleen CT numbers in the normal adult: its usefulness in predicting the presence of diffuse liver disease. Radiology. 1980;137(3):727–9.
  • Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506.
  • Hamming I, Timens W, Bulthuis MLC, Lely AT, Navis GJ van, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol A J Pathol Soc Gt Britain Irel. 2004;203(2):631–7.
  • Chau T, Lee K, Yao H, Tsang T, Chow T, Yeung Y, et al. SARS‐associated viral hepatitis caused by a novel coronavirus: report of three cases. Hepatology. 2004;39(2):302–10.
  • Nseir W, Taha H, Khateeb J, Grosovski M, Assy N. Fatty liver is associated with recurrent bacterial infections independent of metabolic syndrome. Dig Dis Sci. 2011;56(11):3328–34.
  • Yki-Järvinen H. Non-alcoholic fatty liver disease as a cause and a consequence of metabolic syndrome. lancet Diabetes Endocrinol. 2014;2(11):901–10.
  • Sanchis-Gomar F, Lavie CJ, Mehra MR, Henry BM, Lippi G. Obesity and Outcomes in COVID-19: When an Epidemic and Pandemic Collide. Mayo Clin Proc. 2020 Jul;95(7):1445–53.
  • Singh A, Hussain S, Antony B. Non-alcoholic fatty liver disease and clinical outcomes in patients with COVID-19: A comprehensive systematic review and meta-analysis. Diabetes Metab Syndr Clin Res Rev. 2021;15(3):813–22.
  • Hegyi PJ, Váncsa S, Ocskay K, Dembrovszky F, Kiss S, Farkas N, et al. Metabolic Associated Fatty Liver Disease Is Associated With an Increased Risk of Severe COVID-19: A Systematic Review With Meta-Analysis. Front Med. 2021;8(March):1–8.
  • Danna PSC, Buoni GF, Bor S, Coda C, Abruzzese F, Bertoli M, et al. May an incidental finding on chest CT be a predictor of access inintensive care unit? Role of hepatic steatosis in patients affected bySARS-CoV-2. J Public health Res [Internet]. 2022 Oct 1 [cited 2023 Jan 8];11(4). Available from: /pmc/articles/PMC9669506/
  • Forlano R, Mullish BH, Mukherjee SK, Nathwani R, Harlow C, Crook P, et al. In-hospital mortality is associated with inflammatory response in NAFLD patients admitted for COVID-19. PLoS One. 2020;15(10 October):1–15.
  • Portincasa P, Krawczyk M, Smyk W, Lammert F, Di Ciaula A. COVID-19 and non-alcoholic fatty liver disease: Two intersecting pandemics. Vol. 50, European Journal of Clinical Investigation. 2020.

The Effect of Hepatosteatosis on the Course of Chest CT Severity Scores in COVID-19 Patients

Year 2023, Volume: 33 Issue: 5, 491 - 496, 25.10.2023

Ahmet Turan Kaya Burcu Akman Veysel Kaya Şirin Çetin

https://doi.org/10.54005/geneltip.1274160

Abstract

Background/Aims: In the literature, the temporal variation of CT severity score (CT-SS) values on consecutive CTs, which is an indicator of pneumonia severity, according to the presence of hepatosteatosis was not evaluated. We aimed to investigate the effect of hepatosteatosis on the temporal change of CT-SS in COVID-19 patients.
Material and Methods: Our retrospective study included 472 RT-PCR positive COVID-19 patients ( ≥ 18 years old) admitted to our hospital between December 2021 and January 2022. Chest CT severity scores ranging from 0 to 5 were assigned to each lobe of the lung and total CT-SS was obtained. For quantitative analysis, if the hepatic/splenic attenuation ratio was <1, hepatosteatosis was defined. Wilcoxon test was used to evaluate the temporal changes of CT-SS values relative to the presence of hepatosteatosis. p<0.05 was considered statistically significant.
Results: Of the total 472 patients, 255/472 (54%) were hepatosteatosis-positive. The frequency of hepatosteatosis was significantly higher in male patients, 167/255 (65.5%) (p<0.001). The mean age was 64.04±14.35 years. There was no significant difference between ICU admission and hepatosteatosis groups (p=0.269). There was no significant difference between mortality and the presence of hepatosteatosis (p=0.429). There was a significant increase between the 1st and the 2nd CT-SS in patients with hepatosteatosis (p<0.001). The increase in the second CT-SS was higher in patients with hepatosteatosis than in patients without hepatosteatosis.
Conclusion: Hepatosteatosis may be an indicator of poor prognosis in the temporal change of pneumonia severity in COVID-19 patients.

Keywords

COVID-19 Computed tomography severity score hepatosteatosis hepatic-to-splenic attenuation ratio

References

  • WHO. COVID-19 Weekly Epidemiological Update 35. World Heal Organ. 2020;(December):1–3.
  • Li K, Wu J, Wu F, Guo D, Chen L, Fang Z, et al. The clinical and chest CT features associated with severe and critical COVID-19 pneumonia. Invest Radiol. 2020;
  • Chang YC, Yu CJ, Chang SC, Galvin JR, Liu HM, Hsiao CH, et al. Pulmonary sequelae in convalescent patients after severe acute respiratory syndrome: Evaluation with thin-section CT. Radiology. 2005;236(3):1067–75.
  • Le MH, Devaki P, Ha NB, Jun DW, Te HS, Cheung RC, et al. Prevalence of non-Alcoholic fatty liver disease and risk factors for advanced fibrosis and mortality in the United States. PLoS One. 2017 Mar 1;12(3).
  • Palomar-Lever A, Barraza G, Galicia-Alba J, Echeverri-Bolaños M, Escarria-Panesso R, Padua-Barrios J, et al. Hepatic steatosis as an independent risk factor for severe disease in patients with COVID-19: A computed tomography study. Vol. 4, JGH Open. 2020. p. 1102–7.
  • Targher G, Mantovani A, Byrne CD, Wang X-B, Yan H-D, Sun Q-F, et al. Detrimental effects of metabolic dysfunction-associated fatty liver disease and increased neutrophil-to-lymphocyte ratio on severity of COVID-19. Diabetes Metab. 2020;46(6):505–7.
  • Medeiros AK, Barbisan CC, Cruz IR, de Araújo EM, Libânio BB, Albuquerque KS, et al. Higher frequency of hepatic steatosis at CT among COVID-19-positive patients. Abdom Radiol. 2020;45(9):2748–54.
  • Gao F, Zheng KI, Wang X, Yan H, Sun Q, Pan K, et al. Metabolic associated fatty liver disease increases coronavirus disease 2019 disease severity in nondiabetic patients. J Gastroenterol Hepatol. 2021;36(1):204–7.
  • Hamer OW, Aguirre DA, Casola G, Sirlin CB. Imaging features of perivascular fatty infiltration of the liver: initial observations. Radiology. 2005;237(1):159–69.
  • Limanond P, Raman SS, Lassman C, Sayre J, Ghobrial RM, Busuttil RW, et al. Macrovesicular hepatic steatosis in living related liver donors: correlation between CT and histologic findings. Radiology. 2004;230(1):276–80.
  • Iwasaki M, Takada Y, Hayashi M, Minamiguchi S, Haga H, Maetani Y, et al. Noninvasive evaluation of graft steatosis in living donor liver transplantation. Transplantation. 2004;78(10):1501–5.
  • Zeb I, Li D, Nasir K, Katz R, Larijani VN, Budoff MJ. Computed Tomography Scans in the Evaluation of Fatty Liver Disease in a Population Based Study. The Multi-Ethnic Study of Atherosclerosis. Acad Radiol. 2012;19(7):811–8.
  • Guler E, Unal NG, Cinkooglu A, Savas R, Kose T, Pullukcu H, et al. Correlation of liver-to-spleen ratio, lung CT scores, clinical, and laboratory findings of COVID-19 patients with two consecutive CT scans. Abdom Radiol. 2021;46(4):1543–51.
  • Tahtabasi M, Hosbul T, Karaman E, Akin Y, Kilicaslan N, Gezer M, 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(3):47–57.
  • Çoraplı M, Çil E, Oktay C, Kaçmaz H, Çoraplı G, Bulut HT. Role of hepatosteatosis in the prognosis of COVID 19 disease. Clin Imaging. 2021;80(February):1–5.
  • Pan F, Ye T, Sun P, Gui S, Liang B, Li L. Time Course of Lung Changes at Chest CT during Recovery. Radiology. 2020;295(3):715–21.
  • Piekarski J, Goldberg HI, Royal SA, Axel L, Moss AA. Difference between liver and spleen CT numbers in the normal adult: its usefulness in predicting the presence of diffuse liver disease. Radiology. 1980;137(3):727–9.
  • Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506.
  • Hamming I, Timens W, Bulthuis MLC, Lely AT, Navis GJ van, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol A J Pathol Soc Gt Britain Irel. 2004;203(2):631–7.
  • Chau T, Lee K, Yao H, Tsang T, Chow T, Yeung Y, et al. SARS‐associated viral hepatitis caused by a novel coronavirus: report of three cases. Hepatology. 2004;39(2):302–10.
  • Nseir W, Taha H, Khateeb J, Grosovski M, Assy N. Fatty liver is associated with recurrent bacterial infections independent of metabolic syndrome. Dig Dis Sci. 2011;56(11):3328–34.
  • Yki-Järvinen H. Non-alcoholic fatty liver disease as a cause and a consequence of metabolic syndrome. lancet Diabetes Endocrinol. 2014;2(11):901–10.
  • Sanchis-Gomar F, Lavie CJ, Mehra MR, Henry BM, Lippi G. Obesity and Outcomes in COVID-19: When an Epidemic and Pandemic Collide. Mayo Clin Proc. 2020 Jul;95(7):1445–53.
  • Singh A, Hussain S, Antony B. Non-alcoholic fatty liver disease and clinical outcomes in patients with COVID-19: A comprehensive systematic review and meta-analysis. Diabetes Metab Syndr Clin Res Rev. 2021;15(3):813–22.
  • Hegyi PJ, Váncsa S, Ocskay K, Dembrovszky F, Kiss S, Farkas N, et al. Metabolic Associated Fatty Liver Disease Is Associated With an Increased Risk of Severe COVID-19: A Systematic Review With Meta-Analysis. Front Med. 2021;8(March):1–8.
  • Danna PSC, Buoni GF, Bor S, Coda C, Abruzzese F, Bertoli M, et al. May an incidental finding on chest CT be a predictor of access inintensive care unit? Role of hepatic steatosis in patients affected bySARS-CoV-2. J Public health Res [Internet]. 2022 Oct 1 [cited 2023 Jan 8];11(4). Available from: /pmc/articles/PMC9669506/
  • Forlano R, Mullish BH, Mukherjee SK, Nathwani R, Harlow C, Crook P, et al. In-hospital mortality is associated with inflammatory response in NAFLD patients admitted for COVID-19. PLoS One. 2020;15(10 October):1–15.
  • Portincasa P, Krawczyk M, Smyk W, Lammert F, Di Ciaula A. COVID-19 and non-alcoholic fatty liver disease: Two intersecting pandemics. Vol. 50, European Journal of Clinical Investigation. 2020.
There are 28 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Article
Authors

Ahmet Turan Kaya 0000-0001-9803-453X

Burcu Akman 0000-0002-1067-9008

Veysel Kaya 0000-0002-7131-2277

Şirin Çetin 0000-0001-9878-2554

Early Pub Date October 23, 2023
Publication Date October 25, 2023
Submission Date March 30, 2023
Published in Issue Year 2023 Volume: 33 Issue: 5

Cite

Vancouver Kaya AT, Akman B, Kaya V, Çetin Ş. The Effect of Hepatosteatosis on the Course of Chest CT Severity Scores in COVID-19 Patients. Genel Tıp Derg. 2023;33(5):491-6.

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