Fatty liver, a long-lasting symptom of COVID after severe cases?
A majority of patients with long-term COVID-19 who had been hospitalized with severe illness due to COVID-19 had metabolically associated fatty liver disease (dysfunction) (MAFLD), according to an Italian retrospective study.
In an analysis of 235 patients presenting to a post-acute COVID syndrome (PACS) clinic in Italy, 55.3% had MAFLD during follow-up, compared to 37.3% at initial hospital admission (P
“MAFLD was a highly prevalent condition in our cohort of hospitalized COVID-19 patient survivors, and we believe it can be considered a cluster-PACS-independent phenotype, potentially affecting the metabolic and cardiovascular health of patients with COVID-19. PACS,” the band wrote in Open Forum on Infectious Diseases.
In multivariate analysis, independent predictors of MAFLD included metabolic syndrome (OR 2.54, 95% CI 1.13-5.68), insulin resistance (1.50, 95% CI 1.14 -1.96) and body mass index (BMI; OR 1.14, 95% CI 1.04 -1.24).
The researchers explained that while non-alcoholic fatty liver disease “has been classically described as a barometer of metabolic health and carries a high risk of cardiovascular complications and mortality”, the recently proposed name change to MAFLD “describes organ damage targets bidirectionally associated with the metabolic syndrome.”
Raggi said MedPage today that if “a surprising number” of patients had abnormal fatty liver disease in the study, the question is whether this was a manifestation of long COVID.
In the study, an inverse association was observed between MAFLD and the number of PACS clusters (OR 0.86, 95% CI 0.76-0.97), which included dermatological, musculoskeletal, neurocognitive symptoms , psychological, respiratory and sensory (no gastrointestinal clusters were included). Additionally, all correlations between MAFLD and individual clusters were low “or very low,” Raggi said.
“Many of the same risk factors for severe COVID-19 are those that would also be present in MAFLD – obesity, cirrhosis, and a slew of comorbid medical conditions,” said Andrew Talal, MD, MPH, of the University at Buffalo. . in New York, who did not participate in this study.
Furthermore, “infections have already been shown to induce or accelerate the development of MAFLD,” he said. MedPage today. “This report should certainly promote further studies to follow up on these observations.”
The study authors suggested that “a focus on physical activity and weight loss” might help patients with MAFLD and PACS.
For their study, Raggi and colleagues looked at data from 235 adults from the Modena PACS clinic in Italy who presented from July 2020 to April 2021, including 130 people with MAFLD. The patients were all discharged from Modena University Hospital following an episode of severe COVID-19 pneumonia and had a diagnosis of PACS, defined as at least one qualitatively intense “cluster of symptoms”. In 13% of patients, MAFLD was not associated with any specific PACS cluster.
The primary endpoint was the prevalence of MAFLD in these patients. MAFLD at hospital admission was calculated retrospectively using fatty liver index, while transient elastography was used at the first follow-up visit after discharge (median 143 days from the onset of symptoms). Fatty liver index scores were similar at admission and discharge (50% versus 48.1%) but higher during follow-up (71.3%).
The median patient age was 61, the median BMI was 29, and more than two-thirds were male. The average hospital stay was 11.8 days and 19% had received mechanical ventilation. Most of the cohort members had insulin resistance (36%), hypertension (30%) or metabolic syndrome (28%).
The analysis had several limitations, the researchers acknowledged, including unmeasured confounding and potential for bias due to the cross-sectional design. MAFLD data were not collected during hospitalization because transient elastography is difficult to perform in restricted-access units.
Raggi did not report any disclosures. A co-author reported relationships with Gilead, Merck, Novo Nordisk, AbbVie, Pfizer, Novartis, Allergan, Intercept, Merck, TheraTec and an award from the Fonds de la Recherche en Santé du Québec.