RESUMEN
Background and Aim: Hepatic steatosis (HS) is associated with diabetes, hypertension, and obesity, comorbidities recently related to COVID-19 severity. Here, we assessed if tomographic HS is also a risk factor for severe COVID-19 pneumonia. Methods: We included 213 patients with a positive real time polymerase chain reaction (RT-PCR) test and chest computed tomography (CT) from an out-hospital facility and a hospital. We obtained information on demographics; weight; height; smoking history; diabetes; hypertension; and cardiovascular, lung, and renal disease. Two radiologists scored the CO-RADs system (COVID-19 Reporting and Data System) (1 = normal, 2 = inconsistent, 3-4 = indeterminate, and 5 = typical findings) and the chest CT severity index (≥20 of 40 was considered severe disease). They evaluated the liver-to-spleen ratio (CTL/S) and defined tomographic steatosis as a CTL/S index ≤0.9. We used descriptive statistics, χ2 and t student tests, logistic regression, and reported odds ratio (OR) with 95% confidence interval (CI). Results: Of the patients, 61% were men, with a mean age of 51.2 years, 48.3% were CO-RADs 1 and 51.7% CO-RADs 2-5. Severe tomographic disease was present in 103 patients (48.4%), all CO-RADs 5. This group was older; mostly men; and with a higher prevalence of obesity, hypertension, diabetes, and HS (69.9 vs 29%). On multivariate analysis, age (OR 1.058, 95% CI 1.03-1.086, P < 0.0001), male gender (OR 1.9, 95% CI 1.03-3.8, P = 0.04), and HS (OR 4.9, 95% CI 2.4-9.7, P < 0.0001) remained associated. Conclusion: HS was independently associated with severe COVID pneumonia. The physiopathological explanation of this finding remains to be elucidated. CTL/S should be routinely measured in thoracic CT scans in patients with COVID-19 pneumonia.
RESUMEN
Resumen: Durante la pandemia de SARS-CoV-2 se presenta el caso clínico de un hombre joven de 43 años, sin comorbilidades, quien asiste a un concierto en la Ciudad de México y seis días después inicia con un cuadro infeccioso de vías respiratorias altas que evoluciona en seis días a una neumonía con síndrome de insuficiencia respiratoria progresiva aguda (SIRPA) grave. Se confirma infección por SARS-CoV-2 y sobreinfección bacteriana por Staphylococcus aureus meticilino resistente, requiriendo asistencia ventilatoria invasiva y cuidados en la Unidad de Terapia Intensiva del Hospital Bité Medica de la Ciudad de México por un grupo interdisciplinario. El paciente evoluciona favorablemente con hidroxicloroquina y lopinavir/ritonavir, esteroide sistémico, linezolid, estrategias ventilatorias de protección pulmonar y cuidados críticos generales sin desarrollar falla de otros órganos o sistemas.
Abstract: During the SARS-CoV-2 Pandemic, a clinical case of a 43-year-old young man is presented, who after six days of attending a concert in Mexico City developed an infectious of the upper respiratory tract that evolved to a pneumonia with severe acute respiratory distress syndrome (ARDS), confirming SARS CoV2 infection and bacterial superinfection with resistant methicillin Staphylococcus aureus, requiring invasive ventilatory assistance and care in the Intensive Care Unit of the Hospital Bité Medica, Mexico City by an interdisciplinary group. The patient improved with hydroxychloroquine and lopinavir/ritonavir, systemic steroid, linezolid, ventilatory strategies for pulmonary protection, and general critical care without developing failure of other organs or systems.
Resumo: Durante a pandemia de SARS CoV 2, é apresentado o caso clínico de um jovem de 43 anos que assiste a um concerto na Cidade do México e seis dias depois começa com um quadro infeccioso do trato respiratório superior que evolui em seis dias para pneumonia com síndrome do desconforto respiratório agudo grave, confirmando infecção por SARS CoV2 e superinfecção bacteriana com meticilina resistente Staphylococcus aureus, exigindo assistência ventilatória invasiva e cuidados na Unidade de Terapia Intensiva do Hospital Bitémedica, Cidade do México por um grupo interdisciplinar. O paciente progride para melhora com hidroxicloroquina e lopinavir/ritonavir, esteróide sistêmico, linezolida, estratégias ventilatórias para proteção pulmonar e cuidados críticos em geral, sem desenvolver falha de outros órgãos ou sistemas.