Metabolic-Associated Fatty Liver Disease Is Highly Prevalent in the Postacute COVID Syndrome

Abstract

Background Recently a proposal has been advanced to change the traditional definition of Non-Alcoholic Fatty Liver Disease (NAFLD) to Metabolic Associated Fatty Liver Disease (MAFLD), to reflect the cluster of metabolic abnormalities that may be more closely associated with cardiovascular risk. Long COVID is a smoldering inflammatory condition, characterized by several symptom clusters. This study aims to determine the prevalence of MAFLD in patients with post-acute COVID syndrome (PACS) and its association with other PACS-cluster phenotypes. Methods We included 235 patients followed at a single university outpatient clinic. The diagnosis of PACS was based on ≥1 cluster of symptoms: respiratory, neurocognitive, musculoskeletal, psychological, sensory, dermatological. The outcome was prevalence of MAFLD detected by transient elastography during the first post-discharge follow-up outpatient visit. The prevalence of MAFLD at the time of hospital admission was calculated retrospectively using the hepatic steatosis index. Results Of 235 patients, 162 (69%) were men (median age 61). The prevalence of MAFLD was 55.3% at follow-up and 37.3% on admission (p<0.001). Insulin resistance (OR=1.5, 95%CI: 1.14-1.96), body mass index (OR=1.14, 95%CI: 1.04-1.24), and the metabolic syndrome (OR=2.54, 95%CI: 1.13-5.68), were independent predictors of MAFLD. The number of PACS clusters was inversely associated with MAFLD (OR=0.86, 95%CI: 0.76-0.97). Thirty-one patients (13.2%) had MAFLD with no other associated PACS clusters. All correlations between MAFLD and other PACS clusters were weak. Conclusions MAFLD was highly prevalent after hospital discharge and may represent a specific PACS-cluster phenotype, with potential long-term metabolic and cardiovascular health implications.

COVID-19 Pandemic: Insights into Interactions between SARS-CoV-2 Infection and MAFLD

“…A study describing the clinical characteristics of patients with combined MAFLD and COVID-19 found more severe liver injury in MAFLD patients with COVID-19 than in uninfected MAFLD patients [114]. Moreover, another follow-up of 235 discharged patients with COVID-19 found that the prevalence of MAFLD at follow-up was 55.3%, which was greater than the prevalence of MAFLD at admission (37.3%) [115]. Therefore, special attention should be given to the management of patients with MAFLD during the COVID-19 pandemic.…”

Chronic liver disease-related mortality in diabetes before and during the COVID-19 in the United States

“…Being overweight before the pandemic was most likely to gain weight (65%) compared with those who reported being normal-weight (40%) [18] . A recent study reported that metabolic-associated fatty liver disease was highly prevalent at the time of hospital discharge and represented a specific post-acute COVID syndrome, which may affect increased mortality among survivors of COVID-19 [19] . Metabolic-associated fatty liver disease represented a specific post-acute COVID syndrome-cluster phenotype, with potential health consequences from cardiovascular and metabolic abnormalities in long-COVID-19 [19] .…”

Liver, NAFLD and COVID-19

“…Importantly, MAFLD seems to be additionally highly prevalent after hospital discharge among patients infected with COVID-19. Specifically, the prevalence of MAFLD was 55 % in patients with Long-COVID-19, indicating the presence of a specific post-acute phenotype associated with higher risk for future metabolic and cardiovascular complications [111].…”