Researchers Alarmingly Find That Metabolic Associated Fatty Liver Disease (MAFLD) May Be A Prevalent Long-COVID Manifestation!
: Researchers from the University of Modena and Reggio Emilia-Italy, the Policlinico of Modena-Italy and the University of Alberta-Canada have in a new study found that most Post COVID-19 hospitalized patients irrespective if they had moderate or severe COVID-19 disease will ultimately develop fatty liver disease!
A new initiative is underway to change the traditional definition of Non-Alcoholic Fatty Liver Disease (NAFLD) to Metabolic Associated Fatty Liver Disease (MAFLD), to reflect the cluster of metabolic abnormalities that may be more closely associated with cardiovascular risk.
Long COVID is a smoldering inflammatory condition, characterized by several symptom clusters.
The study team This aimed to determine the prevalence of MAFLD in patients with post-acute COVID syndrome (PACS) and its association with other PACS-cluster phenotypes.
The study included 235 patients followed at a single university outpatient clinic. The diagnosis of PACS was based on ≥1 cluster of symptoms: respiratory, neurocognitive, musculoskeletal, psychological, sensory, dermatological. The outcome was prevalence of MAFLD detected by transient elastography during the first post-discharge follow-up outpatient visit. The prevalence of MAFLD at the time of hospital admission was calculated retrospectively using the hepatic steatosis index. Of the 235 patients, 162 (69%) were men (median age 61).
The study findings alarmingly showed that the prevalence of MAFLD was 55.3% at follow-up and 37.3% on admission (p<0.001). Insulin resistance (OR=1.5, 95%CI: 1.14-1.96), body mass index (OR=1.14, 95%CI: 1.04-1.24), and the metabolic syndrome (OR=2.54, 95%CI: 1.13-5.68), were independent predictors of MAFLD. The number of PACS clusters was inversely associated with MAFLD (OR=0.86, 95%CI: 0.76-0.97). Thirty-one patients (13.2%) had MAFLD with no other associated PACS clusters. All correlations between MAFLD and other PACS clusters were weak.
The study findings showed that MAFLD was highly prevalent after hospital discharge and may represent a specific PACS-cluster phenotype, with potential long-term metabolic and cardiovascular health implications.
The study findings were published in the peer reviewed journal: Oxford’s Open Forum Infectious Diseases. https://academic.oup.com/ofid/advance-article/doi/10.1093/ofid/ofac003/6501509
The retrospective study findings confirmed that a majority of long-COVID patients who had been hospitalized for severe COVID-19 illness had metabolic (dysfunction)-associated fatty liver disease (MAFLD).
In the detailed analysis of 235 patients presenting to a post-acute COVID syndrome (PACS) clinic in Italy (The Policlinico of Modena) , 55.3% had MAFLD during follow-up as compared to 37.3% upon their initial hospital admission (P<0.001), reported study leader, Dr Paolo Raggi, MD, of the University of Alberta in Edmonton, and colleagues.
Dr Raggi told Thailand Medical News
, "MAFLD was a highly prevalent condition in our cohort of survivors of hospitalized patients with COVID-19, and we speculate that it may be considered as an independent PACS-cluste
r phenotype, potentially affecting the metabolic and cardiovascular health of patients with PACS."
For the multivariable analysis, independent predictors of MAFLD included metabolic syndrome (OR 2.54, 95% CI 1.13-5.68), insulin resistance (1.50, 95% CI 1.14-1.96), and body mass index (BMI; OR 1.14, 95% CI 1.04-1.24).
The study team explained that while non-alcoholic fatty liver disease "has being classically described as a barometer of metabolic health and carries a high risk of cardiovascular complications and mortality," the recently proposed renaming to MAFLD "describes a target organ damage bi-directionally associated with the metabolic syndrome."
In the research, an inverse association was observed between MAFLD and the number of PACS clusters (OR 0.86, 95% CI 0.76-0.97), which included dermatological, musculoskeletal, neurocognitive, psychological, respiratory, and sensory symptoms (no gastrointestinal cluster was included). Furthermore, all correlations between MAFLD and individual clusters were weak "or very weak.” This raises questions as to whether MAFLD is a manifestation of LONG COVID and further detailed research is warranted.
Dr Andrew Talal, MD, MPH, of the University at Buffalo in New York, who was not involved in this study commented, "Many of the same risk factors for severe COVID-19 are those that would also be present in MAFLD ie obesity, cirrhosis, and a large number of comorbid medical conditions. Also, infections have previously been shown to provoke or accelerate development of MAFLD. This new study findings should definitely promote other studies to follow up on these observations."
The Long COVID-19-MAFLD
research team suggested that "emphasizing physical activity and weight loss" could help patients with MAFLD and PACS.
Dr Raggi and colleagues for the study, examined data on 235 adults from the Modena PACS Clinic in Italy who presented from July 2020 to April 2021, including 130 individuals with MAFLD. Patients had all been discharged from Modena University hospital following a bout of severe COVID-19 pneumonia and had a PACS diagnosis, defined as at least one qualitatively intense "cluster of symptoms." In 13% of patients, MAFLD was not associated with any specific PACS cluster.
The main primary outcome was MAFLD prevalence among these patients. MAFLD at hospital admission was calculated retrospectively using the hepatic steatosis index, while transient elastography was used during the first post-discharge follow-up visit (median 143 days from symptom onset). Hepatic steatosis index scores were similar at admission and discharge (50% vs 48.1%) but higher during follow-up (71.3%).
The median patient age was 61, median BMI was 29, and over two-thirds were men. Mean hospital stay had been 11.8 days, and 19% had received mechanical ventilation. Most in the cohort had insulin resistance (36%), hypertension (30%), or metabolic syndrome (28%).
The research analysis had several limitations, the study team acknowledged, including unmeasured confounding and potential for bias due to the cross-sectional design. MAFLD data were not collected during hospitalization as transient elastography is difficult to perform in restricted-access units.
Despite these limitations, the fact there was a high prevalence of MAFLD among Post-COVID patients with potential long-term metabolic and cardiovascular health implications is already a worrying occurrence that warrants further studies.
Note that Thailand Medical News had recently also covered a study showing that SARS-CoV-2 infection induces the increase of the circulating protein GP73 that causes dysglycaemia, more specifically the GP73 proteins act as a kind of glucogenic hormone contributing to SARS-CoV-2-induced hyperglycemia.
More importantly past published studies, increase of GP73 has been linked to development of liver diseases and also liver cancer specifically hepatocellular carcinoma. Hence, we can expect to witness an increase of liver disease and liver cancer in Long COVID sufferers. https://www.thailandmedical.news/news/breaking-sars-cov-2-infection-induces-increase-of-gp73-that-causes-dysglycaemia-increased-gp73-could-also-imply-future-liver-disease-and-liver-cancer
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