Division of Gastroenterology and Hepatology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.
Department of Data Science, Sejong University College of Software Convergence, Seoul, Korea.
J Korean Med Sci. 2021 Oct 25;36(41):e291. doi: 10.3346/jkms.2021.36.e291.
Evidence for the association between underlying non-alcoholic fatty liver disease (NAFLD), the risk of testing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive, and the clinical consequences of coronavirus disease 2019 (COVID-19) is controversial and scarce. We aimed to investigate the association between the presence of NAFLD and the risk of SARS-CoV-2 infectivity and COVID-19-related outcomes.
We used the population-based, nationwide cohort in South Korea linked with the general health examination records between January 1, 2018 and July 30, 2020. Data for 212,768 adults older than 20 years who underwent SARS-CoV-2 testing from January 1 to May 30, 2020, were obtained. The presence of NAFLDs was defined using three definitions, namely hepatic steatosis index (HSI), fatty liver index (FLI), and claims-based definition. The outcomes were SARS-CoV-2 test positive, COVID-19 severe illness, and related death.
Among 74,244 adults who completed the general health examination, there were 2,251 (3.0%) who were SARS-CoV-2 positive, 438 (0.6%) with severe COVID-19 illness, and 45 (0.06%) COVID-19-related deaths. After exposure-driven propensity score matching, patients with pre-existing HSI-NAFLD, FLI-NAFLD, or claims-based NAFLD had an 11-23% increased risk of SARS-CoV-2 infection (HSI-NAFLD 95% confidence interval [CI], 1-28%; FLI-NAFLD 95% CI, 2-27%; and claims-based NAFLD 95% CI, 2-31%) and a 35-41% increased risk of severe COVID-19 illness (HSI-NAFLD 95% CI, 8-83%; FLI-NAFLD 95% CI, 5-71%; and claims-based NAFLD 95% CI, 1-92%). These associations are more evident as liver fibrosis advanced (based on the BARD scoring system). Similar patterns were observed in several sensitivity analyses including the full-unmatched cohort.
Patients with pre-existing NAFLDs have a higher likelihood of testing SARS-CoV-2 positive and severe COVID-19 illness; this association was more evident in patients with NAFLD with advanced fibrosis. Our results suggest that extra attention should be given to the management of patients with NAFLD during the COVID-19 pandemic.
非酒精性脂肪性肝病（NAFLD）与严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）检测呈阳性风险以及 2019 年冠状病毒病（COVID-19）的临床后果之间的关联证据存在争议且很少。我们旨在研究 NAFLD 与 SARS-CoV-2 感染风险和 COVID-19 相关结局之间的关系。
我们使用了韩国基于人群的全国性队列，该队列与 2018 年 1 月 1 日至 2020 年 7 月 30 日的一般健康检查记录相关联。我们获得了 2020 年 1 月 1 日至 5 月 30 日期间接受 SARS-CoV-2 检测的 212768 名 20 岁以上成年人的数据。NAFLD 的存在使用三个定义来定义，即肝脂肪变性指数（HSI）、脂肪肝指数（FLI）和基于索赔的定义。结局是 SARS-CoV-2 检测阳性、COVID-19 重症和相关死亡。
在完成一般健康检查的 74244 名成年人中，有 2251 名（3.0%）SARS-CoV-2 检测呈阳性，438 名（0.6%）COVID-19 重症，45 名（0.06%）COVID-19 相关死亡。在暴露驱动的倾向评分匹配后，患有先前存在的 HSI-NAFLD、FLI-NAFLD 或基于索赔的 NAFLD 的患者 SARS-CoV-2 感染的风险增加了 11-23%（HSI-NAFLD 的 95%置信区间[CI]为 1-28%；FLI-NAFLD 的 95%CI 为 2-27%；基于索赔的 NAFLD 的 95%CI 为 2-31%），COVID-19 重症的风险增加了 35-41%（HSI-NAFLD 的 95%CI 为 8-83%；FLI-NAFLD 的 95%CI 为 5-71%；基于索赔的 NAFLD 的 95%CI 为 1-92%）。随着肝纤维化的进展（基于 BARD 评分系统），这些关联变得更加明显。在包括全未匹配队列的几项敏感性分析中观察到类似的模式。
患有先前存在的 NAFLD 的患者 SARS-CoV-2 检测呈阳性和 COVID-19 重症的可能性更高；这种关联在纤维化程度较高的 NAFLD 患者中更为明显。我们的研究结果表明，在 COVID-19 大流行期间，应特别注意管理患有 NAFLD 的患者。
