ABSTRACT
Background: Metabolic dysfunction-associated fatty liver disease (MAFLD) is a main public health problem;it is estimates that is the most frequent hepatic disease. In Mexico, MAFLD is prevalent in nearly 30% of its population. In the same way, it is calculated that MAFLD is going to become the first cause of cirrhosis and hepatic cancer worldwide. MAFLD, unlike non-alcoholic fatty liver disease (NAFLD) definition, focus on metabolic dysregulation as the root of the condition. Given the implication of MAFLD on immune regulation and its association with other comorbidities associated with more severe COVID-19 disease, it is plausible that MAFLD could impact the clinical outcomes of COVID-19 in-patients. The study of this association could help us to understand the higher mortality rates by COVID-19 observed in countries with great prevalence of acquired metabolic disease. The objective of this work was to evaluate the association of NAFLD and MAFLD with mortality in hospitalized patients by COVID-19 in Mexico. Methods: All the patients admitted to Central Military Hospital (SEDENA) located in México city with a positive SARS-Cov-2 PCR test from 4 April to 24 June 2020 were analysed. Three groups were formed. 1. Control, 2. NAFLD and 3. MAFLD. MAFLD was defined according to the criteria of international group of experts. Additionally, other variables associated with severity in COVID-19 were obtained, including gender, age, and comorbidities (T2D, hypertension and obesity) to be included in an adjusted model. An unadjusted and adjusted Cox Proportional-Hazard Regression was performed to obtain the mortality Hazard-Ratio among the groups. Results: We studied a total of 348 patients, the mean age was 54.4 (SD 14.7) years, 250 (71.8%) were male, and 182 patients died (52%). The results of the Cox Regression is shown in Figure 1. NAFLD was not statically associated with mortality (adjusted HR 1.62 CI 95% 0.97-2.65, p = 0.06), on the other hand MAFLD was statically associated with mortality (adjusted HR 1.63 CI 95% 1.02-2.59, p = 0.03) Conclusion: In the studied population, MAFLD was associated with increased risk of mortality despite the setting to age, sex, and main comorbidities of the population.
ABSTRACT
Background: Regardless of the initial measures implemented by LA countries in early 2020, the COVID-19 pandemic spread rapidly and by December 31, there were 15 million confirmed cases, and 500,000 deaths. Given the overload of healthcare systems and the need for resource reallocation, a decrease in liver transplantation (LT) activity was expected in most LA countries. However, the real magnitude of this situation has not been described. The aim of this sudy is provide an overview of the impact of the pandemic on LT activity in LA countries. Methods: During 2020, LA countries were invited to nominate representatives to this special interest group (ALEH). Online meetings were arranged to fill a survey on LT activity. Some data was also obtained from the Global Observatory on Donation and Transplantation (GODT). Results: 20 LA countries participated (representing 640 million inhabitants). In 2019, there were 3,847 LT in LA, performed in 14/20 countries (total LT rate:5.96 pmp) with 12% of them (n= 482) with living donors (7/20 countries) (LDLT rate:0.73 pmp). In 2020, there were 2,817 LT (total LT rate:4.4), with 278 LDLT (LDLT rate:0.43 pmp). The pandemic was associated to a decrease of 26% in the LT rate (p < 0.01), and 41% in the LDLT rate (p<0.01). 6/20 countries not performing LT in 2019, kept no LT activity in 2020. When considering countries with LT rates > 5 ppm in 2019 (5/20), there was a decrease of 23% in the LT rate (from 10.63 to 8.16 pmp;p < 0.01) and 43% in the LDLT rate (from 1.41 to 0.79 pmp;p<0.01). When analyzing countries with a lower total LT rate (0,2-5 pmp in 2019) (9/20), there was a decrease in 62% in the total LT rate (from 1.3 to 0.45 pmp, p < 0.01) and of 21% in the LDLT rate (from 0.06 to 0.047 pmp;p NS). COVID-19 cases and deaths (raw data and rates), give biased comparisons between countries, which also depends on the strategies implemented, on the testing rates, and timing of the 1st and 2nd wave peaks Conclusion: The COVID-19 pandemic, had a major impact on LT activity in LA countries, with a 26% decrease in total LT rate (p <0.01) and a 41% decrease in LDLT rates (p < 0.01). The impact was greater in countries with more limited resources and initial lower total LT rates (decrease of 62% in 2020) as compared to countries with initial higher LT rates (decrease of 23%, p < 0,01)). This situation may be related to a longstanding tradition in LT with a more consolidated systems of donation and procurement in countries with higher LT rates. Abbreviations:Pop: Population;Mill: Millions;Dom. Rep.: Dominican Republic;LT: Liver Transplantation;DDLT: Deceased donor LT;LDLT: Living donor LT;LT Rates: per million population (pmp) COVID-19 cases (per 100.000 population).