Coronavirus disease (COVID)-19 is a global pandemic that carries significant morbidity and mortality. However, the effect of COVID-19 on liver disease, and vice versa, is not well-characterized in the United States. Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent condition associated with metabolic disease including diabetes and obesity. We examined the association between NAFLD and COVID19 disease severity in a large cohort of patients.
We retrospectively reviewed a cohort of 396 consecutive adult patients with RT-PCR positive for COVID-19 between March 1 and April 30, 2020 at Michigan Medicine. NAFLD was defined as either prior imaging evidence of steatosis or hepatic steatosis index >36 for Asians or >39 for non-Asians, with no history of alcohol abuse. The primary outcome was disease severity based on admission to intensive care, intubation, death, or the World Health Organization (WHO) ordinal scale. We used multivariable logistic regression to assess the predictors of intensive care, intubation, or death and linear regression for disease severity on WHO ordinal scale. NAFLD was the primary predictor and models were adjusted for age, sex, race, recent healthcare exposure, hypertension, and dyslipidemia.
The median age was 60.5 years, 52% were male, 46% were Black, 41% were White and 54% had NAFLD. Of 396 patients, 86% were hospitalized, 45% required intensive care, 30% required intubation, and 14% died. 213 (54%) patients had NAFLD. Patients with NAFLD were older (65 vs. 57 years; P < 0.001), had higher body mass index (34.5 vs. 26.4; P < 0.001), and higher prevalence of diabetes (45% vs. 34%; P = 0.039) than those without NAFLD (Table 1). NAFLD was independently associated with increased odds of requiring admission to the intensive care unit (odds ratio [OR] 1.66 [1.06-2.62], P = 0.027) and intubation (OR 2.46 [1.50-4.04], P < 0.001), as well as higher WHO ordinal scale (beta 0.43 [0.03-0.84], P = 0.036). There was no significant association between NAFLD and death (OR 0.84 [0.46-1.67], P = 0.62) (Table 2.)
Our study shows that patients with NAFLD were more likely to develop severe disease with COVID-19.