Association of non-alcoholic fatty liver and metabolic-associated fatty liver with COVID-19 outcomes: A systematic review and meta-analysis

Abstract

BACKGROUND Non-alcoholic fatty liver disease (NAFLD) and metabolic-associated fatty liver disease (MAFLD) are on the rise like any other liver disease, and tend to affect 25% of the United States population. The impact of NAFLD and MAFLD on patients with coronavirus disease 2019 (COVID-19) remains unclear. AIM To identify the association of NAFLD and MAFLD with mortality, hospitalization, hospital length of stay, and supplemental oxygen utilization in COVID-19 patients. METHODS A systematic review of literature on Cochrane, Embase, PubMed, ScienceDirect, and Web of Science databases was conducted from January 2019 to July 2022. Studies that evaluated NAFLD/MAFLD using laboratory methods, noninvasive imaging, or liver biopsy were included. The study protocol was registered in PROSPERO (ID CRD42022313259) and PRISMA guidelines were followed. The National Institutes of Health quality assessment tool was used to assess the quality of the studies. Pooled analysis was conducted using software Rev Man version 5.3. The stability of the results was assessed using sensitivity analysis. RESULTS Thirty-two studies with 43388 patients were included in the meta-analysis of whom 8538 (20%) patients were observed to have NAFLD. There were 42254 patients from 28 studies included in the mortality analysis. A total of 2008 patients died from COVID-19; 837 (10.52%) in the NAFLD group and 1171 (3.41%) in the non-NAFLD group. The odds ratio (OR) was 1.38 for mortality with a 95% confidence interval (95%CI) = 0.97-1.95 and P = 0.07. A total of 5043 patients from eight studies were included in the hospital length of stay analysis. There were 1318 patients in the NAFLD group and 3725 patients in the non-NAFLD group. A qualitative synthesis showed that the mean difference in hospital length of stay was about 2 d between the NAFLD and non-NAFLD groups with a 95%CI = 0.71-3.27 and P = 0.002. For hospitalization rates, the OR was 3.25 with a 95%CI of 1.73-6.10 and P = 0.0002. For supplemental oxygen utilization, the OR was 2.04 with a 95%CI of 1.17-3.53 and P = 0.01. CONCLUSION Our meta-analysis suggests that there are increased odds of hospitalization, longer hospital length of stay, and increased use of supplemental oxygen in NAFLD/MAFLD patients.

Association of Non-Alcoholic Fatty Liver Disease and Metabolic-Associated Fatty Liver Disease with COVID-19-Related Intensive Care Unit Outcomes: A Systematic Review and Meta-Analysis

“…These results align with our previous study evaluating mortality in COVID-19 patients with pre-existing MAFLD. We found no significant difference in those with fatty liver disease than those without it, although MAFLD patients appear to have higher rates of hospital admissions and longer in-hospital stays compared to non-MAFLD patients [ 55 ].…”

Telemedicine as an Option for Monitoring Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) Patients Facing the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

“…Meanwhile, comorbidities such as obesity, diabetes, and fatty liver are associated with an elevated risk of developing severe COVID-19 [ 14 , 15 ]. Recent studies have demonstrated that individuals with MAFLD are at a four to six times higher risk of experiencing a worsening of their respiratory signs and symptoms compared to those who do not have fatty liver disease [ 15 ]. A study carried out in China discovered that severe COVID-19 was present in 70 out of 324 patients with fatty liver identified via abdominal computed tomography (CT) scans [ 16 ].…”

“…Meanwhile, comorbidities such as obesity, diabetes, and fatty liver are associated with an elevated risk of developing severe COVID-19 [14,15]. Recent studies have demonstrated that individuals with MAFLD are at a four to six times higher risk of experiencing a worsening of their respiratory signs and symptoms compared to those who do not have fatty liver disease [15].…”