Is steatosis a risk factor for hepatic blunt force injury?

Hepatic steatosis is commonly seen in association with chronic ethanol use, obesity, diabetes mellitus, and infections or intoxications with certain viruses and/or medication/chemicals. Some forensic textbooks argue that livers with fatty infiltration are more susceptible to trauma. A study was designed to evaluate whether individuals with hepatic steatosis were at greater risk for liver trauma than those without steatosis. Individuals dying from blunt force injuries were evaluated for the presence or absence of hepatic trauma and hepatic steatosis. A grading system of steatosis was used resulting in scores ranging from 0 to 3: corresponding to none, mild, moderate, and severe steatosis. A total of 171 cases were reviewed, including 134 men and 37 women ranging from 17 to 61 years of age (average 30 years). Liver injury was present in 90 cases (53%) and absent in 81 cases (47%). A total of 78 cases (45.6%) showed no evidence of steatosis and 93 (54.4%) showed some element of steatosis with 58 (33.9%) showing mild, 19 (11.1%) moderate, and 16 (9.4%) severe steatosis. Statistical analysis failed to reveal an increased incidence of hepatic trauma within any of the steatotic groups as compared with the nonsteatotic group. Therefore, it can be concluded that hepatic steatosis does not lead to an increased risk of sustaining blunt force liver trauma.