Outcome of Patients with Metabolic-Associated Fatty Liver Disease Who Are Infected with SARS-CoV-2: A Meta-Analysis
Keywords:
COVID-19, MAFLD, outcome, severity, mortality, length of hospital staysAbstract
Background: Metabolic-associated fatty liver disease (MAFLD) is excess fat accumulation in the liver due to metabolic syndrome. Coronavirus disease 2019 (COVID-19) is an infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 not only attacks the respiratory system but also involves systemic and extra-pulmonary organ disorders, including liver disorders. This review evaluates the severity of COVID-19, mortality, and length of hospital stays of patients with MAFLD who were infected with SARS-CoV-2. Methods: Literature searches were conducted through various online databases. The risk of bias assessment was conducted by two researchers using the Newcastle Ottawa Scale tool for NRSI studies, and any discrepancies were resolved by another team member. The meta-analysis was performed using Revman 5.4.1 and results were presented in forest plot by calculating the pooled odds ratio or mean difference between the MAFLD and non-MAFLD groups from the evaluated studies with a 95% CI. Results: The results of the meta-analysis using a fixed-effect model from seven studies showed that COVID-19 patients with MAFLD were associated with a higher mortality compared to those without MAFLD (OR 1.41, 95% CI 1.19-1.69, p=0.01, I2 48). However, there were no differences in COVID-19 severity (OR 3.12, IK95% 0.89–11.03, p=0.08, I2 92) and length of hospital stay (MD 1.27, CI95% 0.03–2.52, p=0.04, I2 80) between the two groups. Conclusion: MAFLD patients infected with SARS-CoV-2 were associated with higher mortality than non-MAFLD patients, but they were not associated with greater severity of COVID-19 nor a longer duration of hospitalization.References
Marchesini G, Day CP, Dufour JF, et al. EASL-EASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64(6):1388-402.
Armstrong MJ, Adams LA, Canbay A, et al. Extrahepatic complications of nonalcoholic fatty liver disease. Hepatology. 2014;59(3):1174-97.
Nardo AD, Schneeweiss-Gleixner M, Bakail M, et al. Pathophysiological mechanisms of liver injury in COVID-19. Liver Int. 2021;41(1):20-32.
WHO. WHO COVID-19 dashboard. 2024.
Bramante C, Tignanelli CJ, Dutta N, et al. Non-alcoholic fatty liver disease (NAFLD) and risk of hospitalization for Covid-19. medRxiv 2020.
Younossi ZM, Stepanova M, Lam B, et al. Independent predictors of mortality among patients with NAFLD hospitalized with COVID-19 infection. Hepatol Commun. 2022;6(11):3062-72.
Forlano R, Mullish BH, Mukherjee SK, et al. In-hospital mortality is associated with inflammatory response in NAFLD patients admitted for COVID-19. PloS One. 2020;15(10):e0240400-e.
Gao F, Zheng KI, Wang X-B, et al. Metabolic associated fatty liver disease increases coronavirus disease 2019 disease severity in nondiabetic patients. J Gastroenterol Hepatol. 2021;36(1):204-7.
Wang G, Wu S, Wu C, et al. Association between non-alcoholic fatty liver disease with the susceptibility and outcome of COVID-19: A retrospective study. J Cell Mol Med. 2021;25(24):11212-20.
Ji D, Qin E, Xu J, et al. Non-alcoholic fatty liver diseases in patients with COVID-19: A retrospective study. J. Hepatol. 2020;73(2):451-3.
Zhou YJ, Zheng KI, Wang XB, et al. Metabolic-associated fatty liver disease is associated with severity of COVID-19. Liver Int. 2020;40(9):2160-3.
Madan K, Rastogi R, Bhargava R, et al. Is fatty liver associated with increased mortality and morbidity in Coronavirus disease 2019 (COVID-19) pneumonia? J Clin Exp Hepatol. 2022;12(5):1320-7.
Nath P, Kumar R, Mallick B, et al. Effect of nonalcoholic fatty liver disease (NAFLD) on COVID-19: A single-center study of 3983 patients with review of literature. Cureus. 2022;14(7):e26683-e.
Mahamid M, Nseir W, Khoury T, et al. Nonalcoholic fatty liver disease is associated with COVID-19 severity independently of metabolic syndrome: a retrospective case-control study. Eur J Gastroenterol Hepatol. 2021;33(12):1578-81.
Moctezuma-Velázquez P, Miranda-Zazueta G, Ortiz-Brizuela E, et al. NAFLD determined by Dallas Steatosis Index is associated with poor outcomes in COVID-19 pneumonia: a cohort study. Intern Emerg Med. 2022;17(5):1355-62.
Vrsaljko N, Samadan L, Viskovic K, et al. Association of nonalcoholic fatty liver disease with COVID-19 severity and pulmonary thrombosis: Covidfat, a prospective, observational cohort study. Open Forum Infect Dis. 2022;9(4):ofac073-ofac.
Yoo HW, Jin HY, Yon DK, et al. Non-alcoholic fatty liver disease and COVID-19 susceptibility and outcomes: a Korean nationwide cohort. J Korean Med Sci. 2021;36(41):e291-e.
Yuan Z, Shao Z, Ma L, et al. Clinical severity of SARS-CoV-2 variants during COVID-19 vaccination: A systematic review and meta-analysis. Viruses. 2023;15(10):1994.
Yadaw AS, Li Y-c, Bose S, et al. Clinical features of COVID-19 mortality: development and validation of a clinical prediction model. The Lancet Digital Health 2020;2(10):e516-e25.
Kaur SP, Gupta V. COVID-19 vaccine: A comprehensive status report. Virus Res. 2020;288(198114).
WHO. COVID-19 vaccination, World data [cited 2024 25 April].
Pipitone RM, Ciccioli C, Infantino G, et al. MAFLD: a multisystem disease. Ther Adv Endocrinol Metab 2023.
Downloads
Published
How to Cite
Issue
Section
License
Copyright
The authors who publish in this journal agree to the following requirements:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors can enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) before and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. (See The Effect of Open Access)
Privacy Statement
The names and email addresses entered in this journal site will be used exclusively for the stated purposes of this journal and will not be made available for any other purpose or to any other party.
