Srikanth Sashwath, Garg Vibhor, Subramanian Lakshmi, Verma Jyoti, Sharma Hansika, Klair Harroop Singh, Kavathia Shrenil A, Teja Jithin Kolli, Vasireddy Nikhil Sai, Anmol Kumar, Kolli Dhanush, Bodhankar Shruti Sanjay, Hashmi Sobya, Chauhan Shaylika, Desai Rupak
Department of Medicine, ECU Health Medical Center, Greenville, NC 27834, United States.
Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, United States.
World J Hepatol. 2024 Jun 27;16(6):912-919. doi: 10.4254/wjh.v16.i6.912.
Non-alcoholic fatty liver disease (NAFLD) increases the risk of cardiovascular diseases independently of other risk factors. However, data on its effect on cardiovascular outcomes in coronavirus disease 2019 (COVID-19) hospitalizations with varied obesity levels is scarce. Clinical management and patient care depend on understanding COVID-19 admission results in NAFLD patients with varying obesity levels.
To study the in-hospital outcomes in COVID-19 patients with NAFLD by severity of obesity.
COVID-19 hospitalizations with NAFLD were identified using International Classification of Disease -10 CM codes in the 2020 National Inpatient Sample database. Overweight and Obesity Classes I, II, and III (body mass index 30-40) were compared. Major adverse cardiac and cerebrovascular events (MACCE) (all-cause mortality, acute myocardial infarction, cardiac arrest, and stroke) were compared between groups. Multivariable regression analyses adjusted for sociodemographic, hospitalization features, and comorbidities.
Our analysis comprised 13260 hospitalizations, 7.3% of which were overweight, 24.3% Class I, 24.1% Class II, and 44.3% Class III. Class III obesity includes younger patients, blacks, females, diabetics, and hypertensive patients. On multivariable logistic analysis, Class III obese patients had higher risks of MACCE, inpatient mortality, and respiratory failure than Class I obese patients. Class II obesity showed increased risks of MACCE, inpatient mortality, and respiratory failure than Class I, but not significantly. All obesity classes had non-significant risks of MACCE, inpatient mortality, and respiratory failure compared to the overweight group.
Class III obese NAFLD COVID-19 patients had a greater risk of adverse outcomes than class I. Using the overweight group as the reference, unfavorable outcomes were not significantly different. Morbid obesity had a greater risk of MACCE regardless of the referent group (overweight or Class I obese) compared to overweight NAFLD patients admitted with COVID-19.
非酒精性脂肪性肝病（NAFLD）独立于其他危险因素增加了心血管疾病的风险。然而，关于其对不同肥胖水平的2019冠状病毒病（COVID-19）住院患者心血管结局影响的数据却很匮乏。临床管理和患者护理依赖于了解COVID-19入院结果在不同肥胖水平的NAFLD患者中的情况。
按肥胖严重程度研究患有NAFLD的COVID-19患者的住院结局。
在2020年全国住院患者样本数据库中使用国际疾病分类-10临床修正版代码识别患有NAFLD的COVID-19住院患者。对超重以及肥胖I、II和III级（体重指数30 - 40）进行比较。比较组间主要不良心脑血管事件（MACCE）（全因死亡率、急性心肌梗死、心脏骤停和中风）。对社会人口统计学、住院特征和合并症进行多变量回归分析。
我们的分析包括13260例住院病例，其中7.3%为超重，24.3%为I级肥胖，24.1%为II级肥胖，44.3%为III级肥胖。III级肥胖患者包括更年轻的患者、黑人、女性、糖尿病患者和高血压患者。在多变量逻辑分析中，III级肥胖患者发生MACCE、住院死亡率和呼吸衰竭的风险高于I级肥胖患者。II级肥胖患者发生MACCE、住院死亡率和呼吸衰竭的风险高于I级肥胖患者，但差异不显著。与超重组相比，所有肥胖级别发生MACCE、住院死亡率和呼吸衰竭的风险均无显著差异。
III级肥胖的NAFLD COVID-19患者比I级肥胖患者发生不良结局的风险更高。以超重组作为参照，不良结局无显著差异。与因COVID-19入院的超重NAFLD患者相比，无论参照组是超重组还是I级肥胖组，病态肥胖发生MACCE的风险都更高。
