RESUMO
BackgroundCovid-19 disease causes significant morbidity and mortality through increase inflammation and thrombosis. Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis are states of chronic inflammation and indicate advanced metabolic disease. We sought to understand the risk of hospitalization for Covid-19 associated with NAFLD/NASH. MethodsRetrospective analysis of electronic medical record data of 6,700 adults with a positive SARS-CoV-2 PCR from March 1, 2020 to Aug 25, 2020. Logistic regression and competing risk were used to assess odds of being hospitalized. Additional adjustment was added to assess risk of hospitalization among patients with a prescription for metformin use within the 3 months prior to the SARS-CoV-2 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 gender and race. ResultsA history of NAFLD/NASH was associated with increased odds of admission for Covid-19: logistic regression OR 2.04 (1.55, 2.96, p<0.01), competing risks OR 1.43 (1.09-1.88, p<0.01); and each additional year of having NAFLD/NASH was associated with a significant increased risk of being hospitalized for Covid-19, OR 1.86 (1.43-2.42, p<0.01). After controlling for NAFLD/NASH, persons with obesity had decreased odds of hospitalization for Covid-19, OR 0.41 (0.34-0.49, p<0.01). NAFLD/NASH increased risk of hospitalization in men and women, and in all racial/ethnic subgroups. Mediation treatments for metabolic syndrome were associated with non-significant reduced risk of admission: OR 0.42 (0.18-1.01, p=0.05) for home metformin use and OR 0.40 (0.14-1.17, p=0.10) for home GLP-1RA use. MBS was associated with a significant decreased risk of admission: OR 0.22 (0.05-0.98, p<0.05). ConclusionsNAFLD/NASH is a significant risk factor for hospitalization for Covid-19, and appears to account for risk attributed to obesity. Treatments for metabolic disease mitigated risks from NAFLD/NASH. More research is needed to confirm risk associated with visceral adiposity, and patients should be screened for and informed of treatments for metabolic syndrome. Key QuestionsO_ST_ABSQuestionC_ST_ABSDoes NAFLD/NASH independently increase risk for poor outcomes from Covid-19? FindingsIn this observational study, a history of NAFLD/NASH was associated with a significantly increased odds of hospitalization. Metabolic surgery was protective against admission in persons with NAFLD/NASH and Covid-19. Metformin and glucagon like peptide 1 receptor agonists were associated with non-significant protecting against admission. MeaningTreatment for metabolic syndrome greatly reduce the elevated risk of hospitalization for Covid-19 among persons with NAFLD/NASH.
RESUMO
Objetivo: analizar el riesgo de progresión a SIDA o muerte, valorando el tiempo óptimo de inicio de la terapia antirretroviral altamente activa (TAR). Se consideró la influencia de distintos factores pronósticos en el desempeño del tratamiento. Metodología: se dividió los pacientes en dos grupos: un grupo de inicio temprano (>200 células/mm3) y un grupo de inicio tardío (<200 células/mm3). Se comparó el riesgo de progresar al primer evento entre ambos grupos a través de un análisis de supervivencia. Posteriormentese ajustó dicho riesgo para distintos factores pronósticos a través de modelos de regresión multivariable. Resultados:se incluyeron 191 pacientes en el análisis. 122 difirieron el tratamiento mientras que 69 empezaron tempranamente. Se hallóun HR de 2.75 para la comparación del primer evento. Se encontró riesgo significativo al ajustar para el CD4 basal (HR=5.28) y beneficio significativo para aquellos pacientes con un esquema de 4 drogas (HR=0.39). Conclusiones: el riesgo del grupo tardío de progresar a SIDA o muerte fue 1.75 veces mayor al del grupo temprano. Este riesgo permaneció significativo al ser ajustadopara variables confusoras. Los factores pronósticos más importantes fueron el contaje CD4 inicial, el tipo de TAR y la presencia de una enfermedad oportunista basal.
Aim: to analyze the risk of progression to AIDS or death, evaluating the optimal time of the beginning of the highly active antiretroviral therapy (ART). The influence of different prognostic factors was considered to evaluate the performance of the treatment.Methodology: the patients were divided into two groups: one group of early onset (> 200 cells / mm3) and one group of late onset (< 200 cells / mm3). The risk of progression to the first event within both groups was compared via a survival analysis. Thereafter, this risk was adjusted for different prognostic factors through a multivariate regression model. Results: 191 patients were includedin the analysis. 122 deferred the treatment meanwhile 69 began early. An HR of 2.75 was found for the comparison of the first event. Significant risk was found when we proceeded to the adjustment of the basal CD4 (HR=5.28) and meaningful benefit for those patients with a 4-drug scheme (HR=0.39). Conclusions: the risk to progress to AIDS or death was for the late onset group1.75 times bigger than for the early onset group. This risk remained significant when adjusted for the confounding variables. The most important prognostic factors were the initial CD4 count, the type of ART and the presence of an opportunistic basal disease.
