The Association of Metabolic-associated Fatty Liver Disease with Clinical Outcomes of COVID-19: A Systematic Review and Meta-Analysis

Abstract

Introduction. Metabolic-associated fatty liver disease (MAFLD) is a hepatic manifestation of metabolic syndrome (MS). MAFLD patients have a higher prevalence of COVID-19. MAFLD is also associated with worse clinical outcomes of COVID-19, such as disease severity, ICU admission rate, and higher mortality rates. However, this evidence has not been well characterized in the literature. This meta-analysis aims to determine the clinical outcomes of COVID-19 among MAFLD patients compared to the non-MAFLD group. Methods. A comprehensive search was conducted in CINAHL, PubMed/Medline, and Embase for studies reporting MAFLD prevalence among COVID-19 patients and comparing clinical outcomes such as severity, ICU admission, and mortality among patients with and without MAFLD. We calculated the pooled prevalence of MAFLD among COVID-19 patients. Also, the pooled odds ratios (ORs) with 95% confidence interval (CI) were calculated for clinical outcomes of COVID-19. Results. Twenty observational studies met inclusion criteria involving 13,036 overall study participants, including 2,374 MAFLD patients. The prevalence of COVID-19 among MAFLD patients was 0.28 (95% CI: 0.19-0.39). MAFLD was associated with the COVID-19 disease severity OR: 2.61 (95% CI: 1.77-3.83). Similarly, MAFLD was associated with an increased risk of ICU admission compared to the non-MAFLD group OR: 1.46 (95% CI: 1.12-1.91). Lastly, the association between MAFLD and COVID-19 mortality was not statistically significant OR: 1.25 (95% CI: 0.66-2.37). Conclusions. There was a higher prevalence of MAFLD among COVID-19 patients than the non-MAFLD group. Moreover, MAFLD patients had an increased risk of COVID-19 disease severity and ICU admission rate.

Liver injury in COVID-19 patients with non-alcoholic fatty liver disease: an update

“…In the first meta-analysis of 4 studies [68-71] Pan et al [72] reported a pooled prevalence of 0.31 (95% CI: 0.28-0.35) of NAFLD among COVID-19 patients. Similarly, Hayat et al [73] in a meta-analysis of 16 studies found a pooled prevalence of COVID-19 among NAFLD patients of 0.29 (95% CI: 0.19-0.40; p < 0.001).…”

“…Although some studies have reported that negative outcomes are similar in COVID-19 patients with and without NAFLD, a systematic review specifically assessed NAFLD as a risk factor in patients with COVID-19 and revealed pooled OR for severe COVID-19 in NAFLD [82] while tree systematic reviews with meta-analysis looked several studies to conclude that NAFLD was associated with increased risk of severe COVID-19 and ICU admission [73][74][75][76][77][78][79][80][81][82][83][84] In summary, many studies highlight the role of NAFLD in the progression of COVID-19, but there is still no evidence that NAFLD will affect the prognosis of COVID-19 [85].…”

COVID-19 and metabolic syndrome

“…Meta-analysis of observational studies suggests that metabolic dysfunction associated fatty liver disease (MAFLD) independent risk factor for developing severe COVID-19, requiring hospitalization and ICU admission, but not for mortality [19] . Among obese adults, those with MALFD were 6 times more likely to develop severe COVID-19 compared to those without MAFLD [20] .…”

Outcomes of COVID-19 among patients with liver disease

“…Over the past two decades, the prevalence of CLD has been increasing[ 11 ]. CLD includes NAFLD, alcohol-related liver disease (ALD), and chronic viral hepatitis B and C[ 12 ], and it can progress to fibrosis, cirrhosis, and HCC[ 13 ]. NAFLD, or the recently defined metabolic-associated fatty liver disease (MAFLD), are the most common CLDs, which affect about a quarter of the world’s adult population[ 14 ].…”

“…A systematic review and meta-analysis showed that the proportion of patients with MAFLD and NAFLD ranged from 28% to 50% and from 6% to 38%, respectively, and found that the presence of MAFLD and NAFLD was associated with worse clinical outcomes for COVID - 19[ 67 ]. Although several studies also showed significant associations between MAFLD and NAFLD and severe COVID-19 outcomes[ 13 , 68 ], there is still no strong evidence that the presence of MAFLD affects its prognosis[ 65 ].…”