Clinical Features of Patients With COVID-19 With Nonalcoholic Fatty Liver Disease

Rui Huang; Li Zhu; Jian Wang; Leyang Xue; Longgen Liu; Xuebing Yan; Songping Huang; Yang Li; Xiaomin Yan; Biao Zhang; Tianmin Xu; Chunyang Li; Fang Ji; Fang Ming; Yun Zhao; Juan Cheng; Yinling Wang; Haiyan Zhao; Shuqin Hong; Kang Chen; Xiang-An Zhao; Lei Zou; Dawen Sang; Huaping Shao; Xinying Guan; Xiaobing Chen; Yuxin Chen; Jie Wei; Chuanwu Zhu; Chao Wu

doi:10.1002/hep4.1592

Clinical Features of Patients With COVID-19 With Nonalcoholic Fatty Liver Disease

Hepatol Commun. 2020 Sep 2;4(12):1758-1768. doi: 10.1002/hep4.1592. eCollection 2020 Dec.

Authors

Rui Huang¹, Li Zhu², Jian Wang¹, Leyang Xue³, Longgen Liu⁴, Xuebing Yan⁵, Songping Huang⁶, Yang Li⁷, Xiaomin Yan¹, Biao Zhang⁸, Tianmin Xu⁴, Chunyang Li⁵, Fang Ji⁵, Fang Ming⁶, Yun Zhao⁹, Juan Cheng¹⁰, Yinling Wang², Haiyan Zhao¹¹, Shuqin Hong¹², Kang Chen¹³, Xiang-An Zhao¹⁴, Lei Zou¹⁰, Dawen Sang¹⁰, Huaping Shao¹¹, Xinying Guan¹⁵, Xiaobing Chen¹⁶, Yuxin Chen¹⁷, Jie Wei¹⁸, Chuanwu Zhu², Chao Wu¹

Affiliations

¹ Department of Infectious Diseases Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School Nanjing China.
² Department of Infectious Diseases The Affiliated Infectious Diseases Hospital of Soochow University Suzhou China.
³ Department of Critical Medicine Huai'an No. 4 People's Hospital Huai'an China.
⁴ Department of Infectious Diseases The Third People's Hospital of Changzhou Changzhou China.
⁵ Department of Infectious Diseases Affiliated Hospital of Xuzhou Medical University Xuzhou China.
⁶ Department of Infectious Diseases Nantong Third People's Hospital Nantong University Nantong China.
⁷ Department of Infectious Diseases Taizhou People's Hospital Taizhou China.
⁸ Department of Quality Control Office Huai'an No. 4 People's Hospital Huai'an China.
⁹ Department of Infectious Diseases The Third People's Hospital of Yangzhou Yangzhou China.
¹⁰ Department of Infectious Diseases Yancheng Second People's Hospital Yancheng China.
¹¹ Department of Infectious Diseases The People's Hospital of Suqian Suqian China.
¹² Nursing Department Huai'an No. 4 People's Hospital Huai'an China.
¹³ Department of Tuberculosis The Third People's Hospital of Changzhou Changzhou China.
¹⁴ Department of Gastroenterology Northern Jiangsu People's Hospital Clinical Medical College of Yangzhou University Yangzhou China.
¹⁵ Department of Neurology The Affiliated Hospital of Kangda College of Nanjing Medical University The First People's Hospital of Lianyungang Lianyungang China.
¹⁶ Department of Emergency The Affiliated Hospital of Kangda College of Nanjing Medical University The First People's Hospital of Lianyungang Lianyungang China.
¹⁷ Department of Laboratory Medicine Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School Nanjing China.
¹⁸ Department of Infectious Diseases Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University Nanjing China.

Abstract

Previous studies reported that coronavirus disease 2019 (COVID-19) was likely to result in liver injury. However, few studies investigated liver injury in patients with COVID-19 with chronic liver diseases. We described the clinical features in patients with COVID-19 with nonalcoholic fatty liver disease (NAFLD). Confirmed patients with COVID-19 from hospitals in 10 cities of Jiangsu Province, China, were retrospectively included between January 18, 2020, and February 26, 2020. The hepatic steatosis index (HSI) was used to defined NAFLD. A total of 280 patients with COVID-19 were enrolled. Eighty-six (30.7%) of 280 patients with COVID-19 were diagnosed as NAFLD by HSI. One hundred (35.7%) patients presented abnormal liver function on admission. The median alanine aminotransferase (ALT) levels (34.5 U/L vs. 23.0 U/L; P < 0.001) and the proportion of elevated ALT (>40 U/L) (40.7% vs. 10.8%; P < 0.001) were significantly higher in patients with NAFLD than in patients without NAFLD on admission. The proportion of elevated ALT in patients with NAFLD was also significantly higher than patients without NAFLD (65.1% vs. 38.7%; P < 0.001) during hospitalization. Multivariate analysis showed that age over 50 years (odds ratio [OR], 2.077; 95% confidence interval [CI], 1.183, 3.648; P = 0.011) and concurrent NAFLD (OR, 2.956; 95% CI, 1.526, 5.726; P = 0.001) were independent risk factors of ALT elevation in patients with COVID-19, while the atomized inhalation of interferon α-2b (OR, 0.402; 95% CI, 0.236, 0.683; P = 0.001) was associated with a reduced risk of ALT elevation during hospitalization. No patient developed liver failure or death during hospitalization. The complications and clinical outcomes were comparable between patients with COVID-19 with and without NAFLD. Conclusion: Patients with NAFLD are more likely to develop liver injury when infected by COVID-19. However, no patient developed severe liver-related complications during hospitalization.