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

Jovana Milic; Sara Barbieri; Licia Gozzi; Alberto Brigo; Bianca Beghé; Alessia Verduri; Erica Bacca; Vittorio Iadisernia; Gianluca Cuomo; Giovanni Dolci; Dina Yaacoub; Emanuele Aprile; Michela Belli; Maria Venuta; Marianna Meschiari; Giada Sebastiani; Enrico Clini; Cristina Mussini; Amedeo Lonardo; Giovanni Guaraldi; Paolo Raggi

doi:10.1093/ofid/ofac003

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

Open Forum Infect Dis. 2022 Jan 10;9(3):ofac003. doi: 10.1093/ofid/ofac003. eCollection 2022 Mar.

Authors

Jovana Milic¹, Sara Barbieri¹, Licia Gozzi¹, Alberto Brigo², Bianca Beghé³, Alessia Verduri³, Erica Bacca⁴, Vittorio Iadisernia⁴, Gianluca Cuomo⁴, Giovanni Dolci⁴, Dina Yaacoub⁴, Emanuele Aprile⁴, Michela Belli⁴, Maria Venuta⁴, Marianna Meschiari⁴, Giada Sebastiani^{5

6}, Enrico Clini³, Cristina Mussini^{1

3}, Amedeo Lonardo⁷, Giovanni Guaraldi^{1

4}, Paolo Raggi⁸

Affiliations

¹ Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy.
² University of Modena and Reggio Emilia, Modena, Italy.
³ Respiratory Unit, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy.
⁴ Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy.
⁵ Division of Experimental Medicine, McGill University, Montreal, Québec, Canada.
⁶ Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Québec, Canada.
⁷ Department of Internal Medicine, Azienda Ospedaliero-Universitaria, Ospedale Civile di Baggiovara, Modena, Italy.
⁸ Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.

Abstract

Background: A proposal has recently been advanced to change the traditional definition of nonalcoholic fatty liver disease to metabolic-associated fatty liver disease (MAFLD), to reflect the cluster of metabolic abnormalities that may be more closely associated with cardiovascular risk. Long coronavirus disease 2019 (COVID-19) is a smoldering inflammatory condition, characterized by several symptom clusters. This study aims to determine the prevalence of MAFLD in patients with postacute COVID syndrome (PACS) and its association with other PACS-cluster phenotypes.

Methods: We included 235 patients observed at a single university outpatient clinic. The diagnosis of PACS was based on ≥1 cluster of symptoms: respiratory, neurocognitive, musculoskeletal, psychological, sensory, and dermatological. The outcome was prevalence of MAFLD detected by transient elastography during the first postdischarge 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 < .001). Insulin resistance (odds ratio [OR] = 1.5; 95% confidence interval [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, .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: Metabolic-associated fatty liver disease was highly prevalent after hospital discharge and may represent a specific PACS-cluster phenotype, with potential long-term metabolic and cardiovascular health implications.

Keywords: 19; COVID; metabolic-associated fatty liver disease.