Fatty liver disease associated with increased risk of COVID-19 infection, hospitalization

However, patients who were obese but did not have fatty liver disease were not at increased risk of hospitalization for COVID-19, according to a study of healthy people in a U.K. database who underwent MRI assessment of liver fat markers.

Having a fatty liver was associated with increased risk of both a positive test for COVID-19 and hospitalization for the condition, a recent study found.

The prospective cohort study used data from the U.K. Biobank, which includes more than half a million participants who were healthy at baseline. A total of 41,791 of them, who were ages 50 to 83 years, underwent MRI for assessment of liver fat, liver fibroinflammatory disease, and liver iron. The current study looked at whether those markers were associated with increased risk of testing positive and being hospitalized for COVID-19. Results were published by Frontiers in Medicine on March 29.

Of the patients who underwent MRI, 4,458 had been tested for COVID-19, and of these, 1,043 tested positive. Those with fatty liver (liver fat ≥10%) were at increased risk of testing positive (odds ratio, 1.35; P=0.007). The median body mass index (BMI) was similar in patients with or without a positive test, but it was significantly higher in patients who ended up hospitalized with COVID-19. Patients who had both obesity and fatty liver disease were 5.14 times more likely to be hospitalized with a positive test result (P=0.0006). Among the 7.76% of the obese participants who had normal liver fat, there was no increased risk of a COVID-19 hospitalization.

The eight study patients who were admitted to the ICU with COVID-19 presented with significantly higher liver fat, liver inflammation, and BMI compared to all other COVID-19-positive participants who did not require ICU admission. A similar trend was found for mortality. The study also confirmed some previously shown associations with COVID-19 hospitalizations, including higher risk in men and those with lower socioeconomic status.

The study's identification of a possible relationship between hepatic steatosis and risk of severe COVID-19 disease should motivate patients in this risk group to avoid contracting COVID-19 via social distancing and vaccination, as well as to take efforts to combat fatty liver disease, the authors said. “This may be an important public health message regarding lifestyle choices to reduce your risk as we learn to live with the virus and adapt [to] the new variants over the coming years,” they wrote. The authors called for additional studies to explore the relationship between liver disease and COVID-19.