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Obesity as a risk factor for greater severity of COVID-19 in patients with metabolic associated fatty liver disease.

ABSTRACT: BACKGROUND & AIMS:Coronavirus disease 2019 (COVID-19) has been declared a pandemic in 2020. Patients with metabolic associated fatty liver disease (MAFLD) are often obese and have additional metabolic risk factors which may aggravate the severity of respiratory diseases and of COVID-19. This study aims to investigate the association between MAFLD and COVID-19 severity. METHODS:214 patients with laboratory-confirmed COVID-19 aged between 18 and 75?years from three hospitals in Wenzhou, China were consecutively enrolled. Sixty-six patients with MAFLD were included in the final analysis. COVID-19 was diagnosed as a positive result by high-throughput sequencing or real-time reverse transcriptase-polymerase chain reaction assay of oropharyngeal swab specimens. COVID-19 severity was assessed during hospitalization and classified as severe and non-severe based on the current management guideline. All patients were screened for fatty liver by computed tomography and subsequently diagnosed as MAFLD according to a recent set of consensus diagnostic criteria. Obesity was defined as BMI >25?kg/m2. RESULTS:The presence of obesity in MAFLD patients was associated with a?~?6-fold increased risk of severe COVID-19 illness (unadjusted-OR 5.77, 95% CI 1.19-27.91, p?=?.029). Notably, this association with obesity and COVID-19 severity remained significant (adjusted-OR 6.32, 95% CI 1.16-34.54, p?=?.033) even after adjusting for age, sex, smoking, diabetes, hypertension, and dyslipidaemia. CONCLUSIONS:Our data demonstrate that the risk of obesity to COVID-19 severity is greater in those with, than those without MAFLD.

SUBMITTER: Zheng KI

PROVIDER: S-EPMC7166301 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Letter to the Editor: Obesity as a risk factor for greater severity of COVID-19 in patients with metabolic associated fatty liver disease.

Zheng Kenneth I KI Gao Feng F Wang Xiao-Bo XB Sun Qing-Feng QF Pan Ke-Hua KH Wang Ting-Yao TY Ma Hong-Lei HL Chen Yong-Ping YP Liu Wen-Yue WY George Jacob J Zheng Ming-Hua MH

Metabolism: clinical and experimental 20200419

PMID: 32320741

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Project description:Covid-19 disease causes significant morbidity and mortality through increase inflammation and thrombosis. Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis are states of chronic inflammation and indicate advanced metabolic disease. We sought to understand the risk of hospitalization for Covid-19 associated with NAFLD/NASH. Retrospective analysis of electronic medical record data of 6,700 adults with a positive SARS-CoV-2 PCR from March 1, 2020 to Aug 25, 2020. Logistic regression and competing risk were used to assess odds of being hospitalized. Additional adjustment was added to assess risk of hospitalization among patients with a prescription for metformin use within the 3 months prior to the SARS-CoV-2 PCR result, history of home glucagon-like-peptide 1 receptor agonist (GLP-1 RA) use, and history of metabolic and bariatric surgery (MBS). Interactions were assessed by gender and race. A history of NAFLD/NASH was associated with increased odds of admission for Covid-19: logistic regression OR 2.04 (1.55, 2.96, p<0.01), competing risks OR 1.43 (1.09-1.88, p<0.01); and each additional year of having NAFLD/NASH was associated with a significant increased risk of being hospitalized for Covid-19, OR 1.86 (1.43-2.42, p<0.01). After controlling for NAFLD/NASH, persons with obesity had decreased odds of hospitalization for Covid-19, OR 0.41 (0.34-0.49, p<0.01). NAFLD/NASH increased risk of hospitalization in men and women, and in all racial/ethnic subgroups. Mediation treatments for metabolic syndrome were associated with non-significant reduced risk of admission: OR 0.42 (0.18-1.01, p=0.05) for home metformin use and OR 0.40 (0.14-1.17, p=0.10) for home GLP-1RA use. MBS was associated with a significant decreased risk of admission: OR 0.22 (0.05-0.98, p<0.05). NAFLD/NASH is a significant risk factor for hospitalization for Covid-19, and appears to account for risk attributed to obesity. Treatments for metabolic disease mitigated risks from NAFLD/NASH. More research is needed to confirm risk associated with visceral adiposity, and patients should be screened for and informed of treatments for metabolic syndrome.

Dataset Information

Obesity as a risk factor for greater severity of COVID-19 in patients with metabolic associated fatty liver disease.

Publications

Letter to the Editor: Obesity as a risk factor for greater severity of COVID-19 in patients with metabolic associated fatty liver disease.

Similar Datasets

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