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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 (CT L/S ) and defined tomographic steatosis as a CT L/S  index ≤0.9. We used descriptive statistics, χ 2  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. CT L/S  should be routinely measured in thoracic CT scans in patients with COVID‐19 pneumonia.

Hepatic steatosis as an independent risk factor for severe disease in patients with COVID ‐19: A computed tomography study