 Hello everyone. I am Himakanti. I'm a postgraduate resident studying in Father Muller Medical College, Mangalore. Today I'll be talking about how hepatic seatosis is an independent risk factor for severe disease in patients with COVID-19, a computer tomography study. The aim of the study is to find the association between hepatic seatosis and CT severity among COVID-19 patients admitted in tertiary care hospital. Hepatic seatosis is defined as intrahepatic fat of at least 5% of liver weight. Simple accumulation of triacylglycerols in the liver could be hepatoprotective. However, prolonged hepatic lipid storage may lead to liver metabolic dysfunction, inflammation, and advanced forms of non-alcoholic fatty liver disease. Non-alcoholic hepatic seatosis is associated with obesity, type 2 diabetes, and dyslipidemia. Several mechanisms are involved in the accumulation of intrahepatic fat, including increased flux of fatty acids to the liver, increased de novo lipogenesis, or reduced clearance through beta-oxidation or very low-density lipoprotein secretion. Global prevalence of non-alcoholic fatty liver disease has increased in the past two decades and it has been calculated to be up to 24%. Imaging plays an important role in its assessment and non-enhanced CT has proven to be a useful and accurate non-invasive method for diagnosing hepatic seatosis and quantifying the severity of liver fat. Real-time reverse transcription polymerase chain reaction is accepted as the reference standard in the diagnosis of COVID-19. However, the sensitivity of RT-PCR is reported to be not very high in the literature and the rate of false negativity varies between 30% and 70%. Continuation of negative results in the repeated tests causes difficulties in the diagnosis and delays the treatment. In COVID-19 patients with false negative PCR, the CT of the chest is valuable diagnostic tool with high sensitivity. Although COVID-19 is a disease that primarily affects the lungs, the involvement of different organ systems has also been described in recent studies in the literature. Liver injury related to COVID-19 is a frequently mentioned consequence of such involvement. The relationship between non-alcoholic fatty liver disease and COVID-19 has also been investigated in a limited number of studies. Pre-existing non-alcoholic fatty liver disease is associated with a severe cause of COVID-19. Patients with non-alcoholic fatty liver disease may be vulnerable to COVID-19, thus identifying those with pre-existing liver disease is important in the early stage of the disease. The present study was conducted to find the association between hepatic steatosis and CD severity among COVID-19 patients admitted in tertiary care hospital. This is an observational study. The patients who were clinically suspected of having COVID-19 infection who underwent both chest CT and RT-PCR were included. This study was done in Father Miller Hospital between May to September 2022. Using this formula, the sample size of 96 was obtained. The inclusion criteria, patients who found to be positive on RT-PCR tests and who underwent chest CT scan for COVID-19 and radiologically detected to be CORADS 4 or 5. Exclusion criteria, patients under the age of 18 years and who received an intravenous contrast agent for examinations and the patients with chronic liver disease. Methodology, the observational study was approved by ethics committee of our hospital. The patients clinically suspected of having COVID-19 infection who underwent both chest CT and RT-PCR during the study period were included in the study. In all the patients, PCR and the chest CT were performed on the very same day. High resolution chest CT was performed using both 128 slice multi-detector scanners and 16 slice multi-detector scanners. All the scans were performed without IV contrast media with the patient in the supine position during end inspiration. The following technical parameters were used, tube voltage of 100 kV, tube current at 90 to 300 MAS, spiral pitch factor at 0.98, collimation width of 0.625 and slice thickness of 1.3 mm with a sharp reconstruction kernel. The following CT features were recorded by a radiologist, laterality involved lobes, peripheral versus central involvement, number of lesions, certain lesion types like ground glass opacities, consolidation, inter lobular septal thickening, crazy paving, air bronchograms, linear opacities, adjacent pleural thickening, pleural effusion, halo sign, pericardial effusion, bronchial dilatation, vascular enlargement, ethylactasis and lymphedinopathy. The level of suspicion of COVID-19 has been graded with CORAT score. CORAT is one where COVID-19 is highly unlikely, CT is normal or there are findings indicating a non-infectious disease. CORAT 2, the level of suspicion of COVID-19 is low and CT findings are consistent with other infections. CORAT 3, COVID-19 infection is unsure or indeterminate and CT abnormalities indicate infection but are unsure whether COVID-19 is involved. CORAT 4, where the level of suspicion is high and most CT findings are suspicious but not extremely typical as unilateral ground glass opacities, confluent or multifocal consolidations without a typical location or any other typical finding. CORAT 5, where the level of suspicion is high with typical CT findings. The CT severity score was calculated based on the extent of low bar involvement. Each of the five lung lobes was visually scored on a scale of 0 to 5 with 0 indicating no involvement, 1 indicating less than 5%, 2 indicating 5 to 25%, 3 indicating 26 to 49%, 4 indicating 50 to 75% and 5 indicating more than 75% involvement. The total CT score was the sum of individual low bar scores and range between 0 to 25. 0 being no involvement and 25 at maximum involvement. The main CT adenuation values of the liver and spleen were obtained in Hounsville unit for the detection of hepatic seatosis. The density measurements were made by placing four regions of interest of approximately 150 mm2 in the right lobe of liver and two regions of interest in the spleen and the average was taken. Results in the present study, 96 study participants diagnosed with COVID-19 were included. The mean age of the study was at 57 plus or minus 14 years. Majority that is 50% belong between 61 to 70 years age group. Male were the majority in the study. The mean BMI in kg per meter square was 27 plus or minus 2. Distribution was based on comorbidities show that 63.5% were diabetic, 54% were hypertensive, 3% had cardiac disease, 9% had preexisting lung disease, 19.8% had renal disease and 25% were smokers. Based on the CT findings, 68.7% had Coratz 5 findings, 15.6% each had Coratz 4 and Coratz 6 findings. In the present study, 55 study participants had hepatic seatosis. Based on the CT severity score, a severity score of less than 19 was observed in 38 study participants and more than 20 of CT severity score was observed in 58 study participants. Association between CT score with hepatic seatosis shows a statistically significant association observed as majority that is 47.9% at a CT severity score of more than 20. CT severity in our study also found significant association with age, gender, obesity, hypertension, diabetes, renal disease or any comorbidities as the p-value calculated to be less than 0.05. These are histogram images which show that 68.7% had Coratz 5 and certain comorbidities like obesity, diabetes and hypertension were strongly associated with the severity of the disease. This is an image of a 55-year-old male patient. It's an unhanned CT thorax which shows average harmful unit of about 22 on the right lobe of liver and average harmful unit on spleen shows 51. The liver to spleen ratio is less than 0.9 indicating hepatic seatosis. This is an unhanned CT thorax of 63-year-old male patient. The average harmful unit of liver shows 25 and average harmful unit of spleen is at 57. The liver to spleen ratio is below 0.9 indicating hepatic seatosis. Our study had shown a significant positive correlation between age and CT severity. Similar findings were observed in a study conducted by Andre where in logistic regression analysis the only variables that remain associated with CT severity was age. Carmen also found age above 50 years was the only predictor of increased mortality. Obesity was significantly associated with severity of COVID-19 similar findings were reported in Zeng's study that he reported that the risk of obesity to COVID-19 severity is significantly greater in those with fatty liver disease. Evidence of increased hepatic and circulating interleukin 6 levels in patients with non-alcoholic fatty liver disease which might have an additive or synergistic role in promoting greater severity of COVID-19. Obesity and non-alcoholic fatty liver disease have been associated with increased production of pro-inflammatory cytokines such as human necrosis factor alpha by adipose cells and cooper cells. Present study reported that those with any comorbidities presented with higher CT severity score which is similar to the study findings of Swati in their study reported that severe CT score of more than 15 was found in 33.3% of patients with comorbidity while in 2.5% of cases without comorbidity. There was a strong correlation between the clinical and CT severity score. A meta-analysis noted that the patients with underlying chronic illnesses were more likely to contract the virus and their disease has progressed to severe. It was concluded that COVID-19 has an increasingly rapid and severe progression in patients with underlying medical conditions or comorbidities. Present study observed that hepatic steatosis is significantly associated with CT severity. Similar findings were reported by a study by Andre where hepatic steatosis is associated with CT severity. These are the references. Thank you.