Association of Nonalcoholic Fatty Liver Disease With COVID-19 Severity and Pulmonary Thrombosis: CovidFAT, a Prospective, Observational Cohort Study

Nina Vrsaljko, Lara Samadan, Klaudija Viskovic, Armin Mehmedović, Jelena Budimir, Adriana Vince, Neven Papic, Nina Vrsaljko, Lara Samadan, Klaudija Viskovic, Armin Mehmedović, Jelena Budimir, Adriana Vince, Neven Papic

Abstract

Background: Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease associated with systemic changes in immune response, which might be associated with coronavirus disease 2019 (COVID-19) severity. The aim of this study was to investigate the impact of NAFLD on COVID-19 severity and outcomes.

Methods: A prospective observational study included consecutively hospitalized adult patients, hospitalized between March and June 2021, with severe COVID-19. Patients were screened for fatty liver by ultrasound and subsequently diagnosed with NAFLD. Patients were daily followed until discharge, and demographic, clinical, and laboratory data were collected and correlated to clinical outcomes.

Results: Of the 216 patients included, 120 (55.5%) had NAFLD. The NAFLD group had higher C-reactive protein (interquartile range [IQR]) (84.7 [38.6-129.8] mg/L vs 66.9 [32.2-97.3] mg/L; P = .0340), interleukin-6 (49.19 [22.66-92.04] ng/L vs 13.22 [5.29-39.75] ng/L; P < .0001), aspartate aminotransferase (58 [40-81] IU/L vs 46 [29-82] IU/L; P = .0123), alanine aminotransferase (51 [32-73] IU/L vs 40 [23-69] IU/L; P = .0345), and lactate dehydrogenase (391 [285-483] IU/L vs 324 [247-411] IU/L; P = .0027). The patients with NAFLD had higher disease severity assessed by 7-category ordinal scale, more frequently required high-flow nasal cannula or noninvasive ventilation (26, 21.66%, vs 10, 10.42%; P = .0289), had longer duration of hospitalization (IQR) (10 [8-15] days vs 9 [6-12] days; P = .0018), and more frequently had pulmonary thromboembolism (26.66% vs 13.54%; P = .0191). On multivariable analyses, NAFLD was negatively associated with time to recovery (hazard ratio, 0.64; 95% CI, 0.48 to 0.86) and was identified as a risk factor for pulmonary thrombosis (odds ratio, 2.15; 95% CI, 1.04 to 4.46).

Conclusions: NAFLD is associated with higher COVID-19 severity, more adverse outcomes, and more frequent pulmonary thrombosis.

Keywords: COVID-19; NAFLD; SARS-CoV2; non-alcoholic fatty liver disease; pulmonary thrombosis.

© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

Figures

Figure 1.
Figure 1.
Seven-category ordinal scale at baseline and days 7, 14, and 28, stratified by the presence of NAFLD. Figure shows the patients’ clinical status as assessed on the 7-category ordinal scale on admission and at days 7, 14, and 28, according to the presence of NAFLD. Categories on the ordinal scale were as follows: (1) discharged or ready for discharge; (2) hospitalization in a non-ICU without supplemental oxygen; (3) non-ICU hospitalization with supplemental oxygen; (4) ICU or non-ICU hospitalization with noninvasive ventilation or high-flow oxygen; (5) ICU hospitalization with mechanical ventilation; (6) ICU hospitalization with ECMO or mechanical ventilation and additional organ support; and (7) death. The Wilcoxon rank-sum test was used to calculate differences between groups. Abbreviations: ECMO, extracorporeal membrane oxygenation; HFNC, high-flow nasal cannula; ICU, intensive care unit; NAFLD, nonalcoholic fatty liver disease; NIV, noninvasive ventilation.
Figure 2.
Figure 2.
Kaplan-Meier curves and Cox proportional hazard ratios for time to discharge or readiness for discharge in patients with and without nonalcoholic fatty liver disease. Abbreviations: HR, hazard ratio; NAFLD, nonalcoholic fatty liver disease.

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Source: PubMed

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