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

Umar Hayat; Muhammad Zubair Ashfaq; Luke Johnson; Ryan Ford; Chelsea Wuthnow; Kevin Kadado; Katia El Jurdi; Hayrettin Okut; William Ransom Kilgore; Maha Assi; Ali A Siddiqui

doi:10.17161/kjm.vol15.16522

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

Kans J Med. 2022 Jul 21:15:241-246. doi: 10.17161/kjm.vol15.16522. eCollection 2022.

Authors

Affiliations

¹ Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS.
² Department of Internal Medicine, Creighton University Medical Center, Omaha, NE.
³ Office of Research, University of Kansas School of Medicine-Wichita, Wichita, KS.
⁴ Ascension Medical Group, Wichita, KS.
⁵ Infectious Diseases Consultants, Wichita, KS.
⁶ Division of Gastroenterology, Centura Healthcare, Denver, CO.

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 also is associated with worse clinical outcomes of COVID-19, such as disease severity, intensive care unit (ICU) admission rate, and higher mortality rates. However, this evidence has not been well characterized in the literature. This meta-analysis aimed to determine the clinical outcomes of COVID-19 among MAFLD patients compared to the non-MAFLD group.

Methods: A comprehensive search was conducted in the Cumulative Index of Nursing and Allied Health (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. The pooled prevalence of MAFLD among COVID-19 patients and the pooled odds ratios (OR) with 95% confidence intervals (CI) for clinical outcomes of COVID-19 were calculated.

Results: Sixteen observational studies met inclusion criteria involving a total of 11,484 overall study participants, including 1,746 MAFLD patients. The prevalence of COVID-19 among MAFLD patients was 0.29 (95% CI: 0.19-0.40). MAFLD was associated with the COVID-19 disease severity OR 3.07 (95% CI: 2.30-4.09). 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 1.45 (95% CI: 0.74-2.84).

Conclusions: In this study, a high percentage of COVID-19 patients had MAFLD. Moreover, MAFLD patients had an increased risk of COVID-19 disease severity and ICU admission rate.

Keywords: SARS-CoV-2; critical illness; meta-analysis; non-alcoholic fatty liver disease; statistical data analysis.