Background: Novel coronavirus disease 2019 (COVID-19) is a global pandemic with significant morbidity and mortality Possible association between non-alcoholic fatty liver disease (NAFLD) and worse COVID-19 disease progression has been suggested but not well described in the United States We investigated whether COVID-19 was associated with elevations in liver enzymes or hepatic decompensation in patients with underlying hepatic steatosis Methods: We retrospectively reviewed the charts of consecutive adults treated at the University of Michigan for COVID-19 between March 1 and April 30, 2020 Hepatic steatosis was defined based on imaging &gt;30 days prior to COVID-19 diagnosis Outcomes were: (1) peak ALT or bilirubin following COVID-19 diagnosis, (2) ALT &gt;2 or 5 times upper limit of normal (ULN), defined as the higher of baseline ALT or 19 U/L in women and 30 U/L in men, and (3) jaundice defined as bilirubin &gt;2 or 4 mg/dl We conducted regressions with the above outcomes as dependent variables and hepatic steatosis as the primary predictor These regression models were logistic for outcomes of abnormal ALT or bilirubin and linear for maximal ALT or bilirubin Results: Evidence of steatosis on prior imaging was found in 80/159 (50 3%) patients Overall, 89% of patients were hospitalized, 51% were admitted to intensive care unit, and 16% died Chronic liver disease other than NAFLD was found in 14% of patients, 5% had cirrhosis, and 2 7% had prior liver decompensation with ascites, variceal bleeding, or hepatic encephalopathy Patients with steatosis were younger, more often African-American with higher body mass index than those without steatosis Baseline ALT and total bilirubin were higher in the steatosis group Hepatic steatosis was associated with higher incidence of ALT &gt;2x ULN (OR 2 93 [1 23-6 97]) or &gt;5x ULN (OR 6 21 [1 45-26 62]), and with peak ALT (beta 39 7 [7 85-71 49]) Hepatic steatosis was not associated with increased bilirubin Rates of liver decompensation were very low: 1 3% and 2 5%, respectively, with no difference based on NAFLD status (p &gt; 0 4 for both) (Table 1) Conclusion: Analysis from our cohort showed that NALFD is associated with acute hepatocellular injury in patients with COVID-19 Strengths of this study include granularity of data available for review Weaknesses include the observational and single-center nature of the study Larger scale multi-center studies are needed to corroborate these findings (Table Presented)
Hepatic steatosis is associated with elevated alanine aminotransferase (ALT) but not elevated bilirubin or hepatic decompensation in patients with novel coronavirus disease 2019 (COVID-19)