非酒精性脂肪肝和代谢相关脂肪性肝病与 COVID-19 结局的关系：系统评价和荟萃分析。
Association of non-alcoholic fatty liver and metabolic-associated fatty liver with COVID-19 outcomes: A systematic review and meta-analysis.
机构信息
Department of Medicine, Saint Michaels Medical Center, Newark, NJ 07102, United States.
Department of Medicine, Green Life Medical College and Hospital, Dhaka 1205, Bangladesh.
出版信息
World J Gastroenterol. 2023 Jun 7;29(21):3362-3378. doi: 10.3748/wjg.v29.i21.3362.
BACKGROUND
Non-alcoholic fatty liver disease (NAFLD) and metabolic-associated fatty liver disease (MAFLD) are on the rise like any other liver disease, and tend to affect 25% of the United States population. The impact of NAFLD and MAFLD on patients with coronavirus disease 2019 (COVID-19) remains unclear.
AIM
To identify the association of NAFLD and MAFLD with mortality, hospitalization, hospital length of stay, and supplemental oxygen utilization in COVID-19 patients.
METHODS
A systematic review of literature on Cochrane, Embase, PubMed, ScienceDirect, and Web of Science databases was conducted from January 2019 to July 2022. Studies that evaluated NAFLD/MAFLD using laboratory methods, noninvasive imaging, or liver biopsy were included. The study protocol was registered in PROSPERO (ID CRD42022313259) and PRISMA guidelines were followed. The National Institutes of Health quality assessment tool was used to assess the quality of the studies. Pooled analysis was conducted using software Rev Man version 5.3. The stability of the results was assessed using sensitivity analysis.
RESULTS
Thirty-two studies with 43388 patients were included in the meta-analysis of whom 8538 (20%) patients were observed to have NAFLD. There were 42254 patients from 28 studies included in the mortality analysis. A total of 2008 patients died from COVID-19; 837 (10.52%) in the NAFLD group and 1171 (3.41%) in the non-NAFLD group. The odds ratio (OR) was 1.38 for mortality with a 95% confidence interval (95%CI) = 0.97-1.95 and = 0.07. A total of 5043 patients from eight studies were included in the hospital length of stay analysis. There were 1318 patients in the NAFLD group and 3725 patients in the non-NAFLD group. A qualitative synthesis showed that the mean difference in hospital length of stay was about 2 d between the NAFLD and non-NAFLD groups with a 95%CI = 0.71-3.27 and = 0.002. For hospitalization rates, the OR was 3.25 with a 95%CI of 1.73-6.10 and = 0.0002. For supplemental oxygen utilization, the OR was 2.04 with a 95%CI of 1.17-3.53 and = 0.01.
CONCLUSION
Our meta-analysis suggests that there are increased odds of hospitalization, longer hospital length of stay, and increased use of supplemental oxygen in NAFLD/MAFLD patients.
背景
非酒精性脂肪性肝病（NAFLD）和代谢相关脂肪性肝病（MAFLD）与其他肝病一样呈上升趋势，且倾向于影响美国 25%的人口。NAFLD 和 MAFLD 对 2019 年冠状病毒病（COVID-19）患者的影响仍不清楚。
目的
确定 NAFLD 和 MAFLD 与 COVID-19 患者死亡率、住院、住院时间和补充氧气使用之间的关联。
方法
对 Cochrane、Embase、PubMed、ScienceDirect 和 Web of Science 数据库进行了系统文献综述，时间范围为 2019 年 1 月至 2022 年 7 月。纳入使用实验室方法、非侵入性成像或肝活检评估 NAFLD/MAFLD 的研究。研究方案在 PROSPERO（ID CRD42022313259）中进行了注册，并遵循 PRISMA 指南。使用国家卫生研究院质量评估工具评估研究质量。使用 Rev Man 版本 5.3 软件进行汇总分析。使用敏感性分析评估结果的稳定性。
结果
纳入了 32 项研究，共 43388 例患者，其中 8538 例（20%）患者被观察到患有 NAFLD。纳入了 28 项研究中 42254 例患者的死亡率分析。共有 2008 例 COVID-19 患者死亡；NAFLD 组 837 例（10.52%），非 NAFLD 组 1171 例（3.41%）。死亡率的优势比（OR）为 1.38，95%置信区间（95%CI）为 0.97-1.95， = 0.07。纳入了 8 项研究中 5043 例患者的住院时间分析。NAFLD 组 1318 例，非 NAFLD 组 3725 例。定性综合显示，NAFLD 组和非 NAFLD 组之间的平均住院时间差异约为 2 天，95%CI = 0.71-3.27， = 0.002。对于住院率，OR 为 3.25，95%CI 为 1.73-6.10， = 0.0002。对于补充氧气的使用，OR 为 2.04，95%CI 为 1.17-3.53， = 0.01。
结论
我们的荟萃分析表明，NAFLD/MAFLD 患者的住院、住院时间延长和补充氧气使用的几率增加。
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