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Non-alcoholic fatty liver diseases in patients with COVID-19: A retrospective study
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Patients with NAFLD had a higher risk of disease progression (6.6% [5/126] vs. 44.7% [34/76] p <0.0001), higher likelihood of abnormal liver function from admission to discharge (70% [53/76] vs. 11.1% [14/126]; p <0.0001) and longer viral shedding time (17.5 ± 5.2 days vs. 12.1 ± 4.4 days p <0.0001) compared to patients without NAFLD.
PLWH have unidentified & undiagnosed high rates of fatty liver disease, NAFLD & NASH. Studies are showing fatty liver disease to cause more severe COVID disease.
AASLD: Fat in the Liver Not Obesity Increased COVID Testing Positive & Hospitalization with Symptomatic COVID (11/24/20)
To the Editor:
Liver injury has been observed in patients with COVID-19, at an incidence ranging from 14-53%.
We examined the liver injury patterns and implication of non-alcoholic fatty liver diseases (NAFLD) on clinical outcomes in Chinese patients with COVID-19.
From January 20 through February 17, 2020, consecutive patients admitted to 2 designated COVID-19 Hospitals in China with confirmed COVID-19 and information on NAFLD status were studied. The diagnosis and clinical management of patients with COVID-19 were conducted in accordance with the practice guidelines issued by The Chinese National Health Commission.
COVID-19 was confirmed by the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequences in the throat swab by reverse transcription PCR. Liver injury was defined as hepatocellular if the alanine aminotransferase (ALT) level was >30 IU/L for males and >19 IU/L for females ; ductular if alkaline phosphatase (ALP) was >the upper limit of normal (ULN) accompanied by gamma-glutamyltransferase (GGT) >ULN; mixed if both hepatocellular and ductular enzymes were raised >ULN. NAFLD was identified as hepatic steatosis index (HSI = 8 × [ALT/AST] + BMI [+ 2 if type 2 diabetes yes, + 2 if female]) >36 points and/or by abdominal ultrasound examination.
The ALT/AST value used for HSI was taken either at complete recovery on discharge or from records of the patients before and within 12 months of the diagnosis of COVID-19. The patients were followed till discharged with recovery or disease progression. The study was approved by the Ethics Committees of FYSPH (20200303006) and the Fifth Medical Center of PLAGH (2020005D).
The significance of clinical characteristics on admission were assessed by univariate and multivariate logistic regression analysis to investigate the independent risk factors of disease progression. p values <0.05 were considered significant.
Two hundred and two consecutive patients with confirmed COVID-19 and information relating to NAFLD status were studied. Liver injury was observed in 101 (50%) and 152 (75.2%) patients on admission and during hospitalization, respectively. Almost all liver injury was mild with hepatocellular pattern, only 2.6% (4/152) had ductular or mixed pattern. Sixty-seven (33.2%) patients had persistent abnormal liver function from admission to last follow-up. Thirty-nine (19.3%) and 163 (80.7%) had progressive and stable disease, respectively. Patients with progressive disease were older, had higher BMI, and a higher percentage of comorbidity and NAFLD (Table 1). Univariate and multivariate logistic regression analysis showed that male sex (odds ratio [OR] 3.1; 95% CI 1.1-9.4), age >60 years (OR 4.8; 95% CI 1.5-16.2), higher BMI (OR 1.3; 95% CI 1.0-1.8), underlying comorbidity (OR 6.3; 95% CI 2.3-18.8) and NAFLD (OR 6.4; 95% CI 1.5 - 31.2), were associated with COVID-19 progression.

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