Investigation of the effect of existing fatty liver in patients with covid-19 on liver tests during admission

Introduction: At the end of December 2019, the World Health Organization (WHO) China Country Office reported cases of pneumonia of unknown cause in the city of Wuhan. In January 2020, the causative agent of these pneumonia cases was named as a new coronavirus (2019-nCoV). The disease caused by 2019- nCoV has been defined as COVID-19. It was found that there is a close similarity between this new virus and SARS CoV, and due to this similarity, the name 2019-nCoV was changed to SARS-CoV-2. There are different views on the systemic effects of COVID-19; In some reports, varying levels of liver disease have been reported in more than half of patients with COVID-19. Studies have suggested that patients with abnormal liver test results have a high risk of progression to severe disease . However, there is no definite information about the presence of underlying liver disease and the presentations of the patients. We have seen that there is no specific information on how much nonalcoholic fatty liver disease (NAFLD), which is common in the community, changes the liver tests at their arrival. Probably, some of the patients hospitalized with COVID 19 also have NAFLD, and it may affect the presentation and course of the disease. In our study, we investigated the effect of existing fatty liver on liver tests at the time of admission. Patients and Methods: This study was conducted retrospectively in patients hospitalized in Hacettepe University Hospital pandemic clinics or followed up in COVID-19 outpatient clinics between March 11, 2020 and June 15, 2020. Patients who did not have a liver test or thoracic tomography at the time of admission, patients with a diagnosis of hepatitis B and alcoholic cirrhosis were excluded. Among the patients included in the study, those who had positive results of RT-PCR and serological tests such as ELISA or rapid antibody tests, those whose RT-PCR result was negative and whose CT result was typical for COVID-19 or COVID-19 could not be ruled out, were diagnosed with COVID-19. COVID-19 diagnosis was excluded and included in the control group in patients whose RT-PCR results were negative and CT results were reported to be incompatible with COVID-19 or as no sign of pneumonia. Liver and spleen tissues in the lowest segments of the patients on thoracic tomography were evaluated in terms of fatty liver. Liver tests of the patients with and without fatty liver diagnosed with COVID-19 were compared. It was assumed that liver tests of patients with COVID-19 diagnosis and fatty liver at the time of admission would be high regardless of COVID-19. SPSS 23 program was used for statistical analysis. Results: Data of a total of 517 patients were evaluated in the study. 84 patients without liver test or thoracic tomography at admission, 8 patients a diagnosis of hepatitis B and 1 patient with alcoholic cirrhosis were excluded. A total of 424 patients who applied to an outpatient clinic with suspicion of COVID-19 diagnosis and were interned to the service or intensive care unit were included in the study. 53.1% of the patients in the study were men and 46.9% were women. In addition, the average age of the patients is 45.61 ± 16.82 (Min .: 18 - max .: 96). 196 of the patients had chronic disease at follow-up. Of these patients, 70 patients (35.71%) had HT, 53 patients (27.04%) type 2 DM, and 14 patients (7.14%) had hyperlipidemia. 176 patients were using regular medication for their chronic diseases at the time of admission. There were 16 patients who were previously diagnosed with fatty liver by USG and CT. A diagnosis of COVID-19 was made in 321 (75.7%) of the patients. BMI data of 400 patients were available. 51.1% of the patients were overweight (34.8%) and obese (16.3%). Based on CT imaging, 27.1% of the patients were diagnosed with fatty liver. Patients with a L / S ratio of less than 0.8 were considered as severe steatosis and severe steatosis was present in 10.6% of the patients. The median of liver test values of the patients included in the study: ALT 19.0, AST 24.0, ALP 75.0, GGT 24.0, bilirubin total 0.51, indirect bilirubin 0.40, direct bilirubin 0.11. The median of liver tests in patients with COVID-19 and without fatty liver: ALT 18.0, AST 23.0, ALP 73.0, GGT 19.0, total bilirubin 0.48, indirect bilirubin 0.37, direct bilirubin 0.11. Median of liver tests in patients with COVID-19 diagnosis and fatty liver: ALT 29.0, AST 29.0, ALP 78.0, GGT 38.0, total bilirubin 0.60, indirect bilirubin 0.45, direct bilirubin 0.13. We found that ALT, AST, GGT, total bilirubin, direct bilirubin values were statistically significantly higher in patients with COVID-19 diagnosis and steatosis (P <0.05). We validated our hypothesis and showed that NAFLD affects liver tests during admission in patients with a diagnosis of COVID-19. Until now, NCov-19 has not been shown to affect the liver intensively. The severity of COVID-19 affected the liver presentation on arrival and the values deteriorated due to the antivirals administered during the course. Its effect on NAFLD, which is common in the society, was not known exactly. Similar to the literature, we showed that patients with fatty liver had high liver tests on arrival. Perhaps one of the important aspects of this study is that it is the first study in which CT segments are evaluated and lubrication is evaluated objectively. In addition, thanks to the detailed evaluation made during the hospitalization, we have learned information about weight distribution in Turkish society that relieved us a little. We think that this unselected COVID-19 patient group fully reflects the prevalence of fatty liver in our country. Combining data with different centers will provide more valuable information on NAFLD.