COVID-19 in patients with pre-existing chronic liver disease – predictors of outcomes

Table 3 Studies evaluating outcomes and predictors of severity in non-alcoholic fatty liver disease with coronavirus disease 2019

Ref.	Type of study	Patients included	Outcomes	Predictors
Chang et al[27]	Retrospective study	3122 COVID-19 cases [FLI (fatty liver index) was calculated]	Severe disease: 223 (7.14%); Mechanical ventilation: 82 (2.63%); ICU admission: 126 (4.04%) High-flow oxygen therapy: 75 (2.40%); Death: 94 (3.01%)	FLI associated with severe complications from COVID-19 (aOR: 1.77)
Vrsaljko et al[28]	Prospective observational study	120 NAFLD patients (of 216 COVID-19 patients)	Patients with NAFLD had more high-flow nasal cannula or non-invasive ventilation (21.66%, vs 10.42%), longer duration of hospitalization (10 d vs 9 d), and more pulmonary thromboembolism risk (26.66% vs 13.54%)	Delayed time to recovery (HR: 0.64); Increased pulmonary thrombosis (OR: 2.15) among NAFLD patients
Velazquez et al[29]	Retrospective cohort study	359 NAFLD patients as per Dallas steatosis index (DSI) out of total 470 cases	Lower oxygen saturation levels; Higher D-dimer; Elevated LDH; Higher lymphocyte count among NAFLD	On multivariable analysis, NAFLD is a predictor of mortality (OR: 2.13)
Madan et al[36]	Retrospective observational case control study	289 NAFLD patients among 446 cases	Similar in-hospital mortality, ICU requirement, ventilatory support, and duration of ICU and hospital stay	Predictors of in-hospital mortality: High total leukocyte count (OR: 1.082); High FIB-4 (OR: 1.606)
Chen et al[34]	Retrospective single centre cohort study	172 patients with hepatic steatosis (HS) among 342 cases	19% of patients expired; > 50% required ICU admission	Increased intubation (aOR: 2.75); Vasopressor requirements (aOR: 1.22); ALT > 5 x ULN (aOR: 7.09)
Sarin et al[37]	Retrospective multinational cohort	113 NAFLD cases out of 228 cases (185 without cirrhosis and 43 with cirrhosis)	Higher risk of acute liver injury in obese cirrhotics vs normal weight patients (OR: 8.9)	Higher risk of liver injury: In non-cirrhotics, diabetes [57.7% vs 39.7%, OR: 2.1]; In cirrhotics, obesity, [64.3% vs 17.2%, OR: 8.1]
Li et al[31]	Observational study	Genome-wide meta-analysis (GWMA) of 3711 NAFLD cases and 426252 controls from United Kingdom Biobank data	No significant association of NAFLD and severe COVID-19 after adjusting for confounders	Predictors of severity: Body mass index (OR: 1.73); Waist circumference (OR: 1.76); Hip circumference (OR: 1.33)
Yao et al[30]	Retrospective study in China	86 COVID-19 patients with NAFLD	NAFLD patients with advanced fibrosis (NFS > -1.5) had more fever (81.6% vs 50%), shortness of breath (18.4% vs 0%), and severe disease (28.9% vs 2.1)	Predictors of severe disease: Diabetes (OR: 8.264); Advanced liver fibrosis [NFS > -1.5] (OR: 11.057)
Targher et al[35]	Retrospective study	94 NAFLD cases among 310 patients		Factors associated with severity: Increasing FIB-4 (aOR: 1.90); Increasing NFS (aOR: 2.57)

aOR: Adjusted odds ratio; ALT: Alanine transaminase; AST: Aspartate aminotransferase; COVID: Coronavirus disease; CLD: Chronic liver disease; FIB-4: Fibrosis 4; NFS: NAFLD fibrosis score; FLI: Fatty liver index; GWAS: Genome wide association studies; ICU: Intensive care unit; LDH: Lactate dehydrogenase; NAFLD: Non-alcoholic fatty liver disease; TLC: Total leukocyte count; ULN: Upper limit of normal.