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Metabolic surgery may protect against admission for COVID-19 in persons with nonalcoholic fatty liver disease.
Tignanelli, Christopher J; Bramante, Carolyn T; Dutta, Nirjhar; Tamariz, Leonardo; Usher, Michael G; Ikramuddin, Sayeed.
  • Tignanelli CJ; Department of Surgery, University of Minnesota, Division of Surgical Oncology, Minneapolis, Minnesota. Electronic address: bramante@umn.edu.
  • Bramante CT; Department of Medicine, University of Minnesota, Division of General Internal Medicine, Minneapolis, Minnesota.
  • Dutta N; Department of Medicine, University of Minnesota, Division of General Internal Medicine, Minneapolis, Minnesota.
  • Tamariz L; Division of Cardiology, University of Miami, and Miami VA Healthcare Administration, Miami, Florida.
  • Usher MG; Department of Medicine, University of Minnesota, Division of General Internal Medicine, Minneapolis, Minnesota.
  • Ikramuddin S; Department of Surgery, University of Minnesota, Division of Surgical Oncology, Minneapolis, Minnesota.
Surg Obes Relat Dis ; 17(10): 1780-1786, 2021 10.
Article in English | MEDLINE | ID: covidwho-1333752
ABSTRACT

BACKGROUND:

SARS-CoV-2 (COVID-19) disease causes significant morbidity and mortality through increased inflammation and thrombosis. Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are states of chronic inflammation and indicate advanced metabolic disease.

OBJECTIVE:

The purpose of this observational study was to characterize the risk of hospitalization for COVID-19 in patients with NAFLD/NASH and evaluate the mitigating effect of various metabolic treatments.

SETTING:

Retrospective analysis of electronic medical record data of 26,896 adults from a 12-hospital Midwest healthcare system with a positive COVID-19 polymerase chain reaction (PCR) test from March 1, 2020, to January 26, 2021.

METHODS:

Variable selection was guided by the least absolute shrinkage and selection operator (LASSO) method, and multiple imputation was used to account for missing data. Multivariable logistic regression and competing risk models were used to assess the odds of being hospitalized within 45 days of a COVID-19 diagnosis. Analysis assessed the risk of hospitalization among patients with a prescription for metformin and statin use within the 3 months prior to the COVID-19 PCR result, history of home glucagon-like peptide 1 receptor agonist (GLP-1 RA) use, and history of metabolic and bariatric surgery (MBS). Interactions were assessed by sex and race.

RESULTS:

A history of NAFLD/NASH was associated with increased odds of admission for COVID-19 (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.57-2.26; P < .001) and mortality (OR, 1.96; 95% CI, 1.45-2.67; P < .001). Each additional year of having NAFLD/NASH was associated with a significant increased risk of being hospitalized for COVID-19 (OR, 1.24; 95% CI, 1.14-1.35; P < .001). NAFLD/NASH increased the risk of hospitalization in men, but not women, and increased the risk of hospitalization in all multiracial/multiethnic subgroups. Medication treatments for metabolic syndrome were associated with significantly reduced risk of admission (OR, .81; 95% CI, .67-.99; P < .001 for home metformin use; OR, .71; 95% CI, .65-.83; P < .001 for home statin use). MBS was associated with a significant decreased risk of admission (OR, .48; 95% CI, .33-.69; P < .001).

CONCLUSIONS:

NAFLD/NASH is a significant risk factor for hospitalization for COVID-19 and appears to account for risk attributed to obesity. Other significant risks include factors associated with socioeconomic status and other co-morbidities, such as history of venous thromboembolism. Treatments for metabolic disease mitigated risks from NAFLD/NASH. More research is needed to confirm the risk associated with visceral adiposity, and patients should be screened for and informed of treatments for metabolic syndrome.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Bariatric Surgery / Non-alcoholic Fatty Liver Disease / COVID-19 Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Adult / Humans / Male Language: English Journal: Surg Obes Relat Dis Journal subject: Metabolism Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Bariatric Surgery / Non-alcoholic Fatty Liver Disease / COVID-19 Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Adult / Humans / Male Language: English Journal: Surg Obes Relat Dis Journal subject: Metabolism Year: 2021 Document Type: Article