In-hospital mortality is associated with inflammatory response in NAFLD patients admitted for COVID-19

ABSTRACT

Background: Although metabolic risk factors are associated with more severe COVID-19, there is little evidence on outcomes in patients with non-alcoholic fatty liver disease(NAFLD) We here describe the clinical characteristics and outcomes of NAFLD patients in a cohort hospitalised for COVID-19 Methods: This study included all consecutive patients admitted for COVID-19 between February and April 2020 at Imperial College Healthcare NHS Trust, with either imaging of the liver available dated within one year from the admission or a known diagnosis of NAFLD Clinical data and early weaning score(EWS) were recorded NAFLD diagnosis was based on imaging or past medical history andpatients were stratified for Fibrosis-4(FIB-4)index. Clinical endpoints were admission to intensive care unit(ICU)and in-hospital mortality Results: 561 patients were admitted Overall, 193 patients were included in the study Fifty nine patients(30%) died, 9(5%) were still in hospital, and 125(65%) were discharged. The NAFLD cohort(n=61) was significantly younger(60 vs 70 5 years, p=0 046) at presentation compared to the non-NAFLD(n=132) NAFLD diagnosis was not associated with adverse outcomes However,the NAFLD group had higher C reactive protein(CRP) (107 vs 91 2 mg/L,p=0 05) compared to non-NAFLD(n=132) Among NAFLD patients, male gender(p=0 01), ferritin(p=0 003) and EWS(p=0 047) were associated with in-hospital mortality,while the presence of intermediate/high risk FIB-4 or liver cirrhosis was not Conclusion: The presence of NAFLD per se was not associated with worse outcomes in patients hospitalised for COVID-19 Though NAFLD patients were younger on admission,disease stage was not associated with clinical outcomes Yet, mortality was associated with gender and a pronounced inflammatory response in the NAFLD group.