Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 27, 2024; 16(6): 912-919
Published online Jun 27, 2024. doi: 10.4254/wjh.v16.i6.912
In-hospital outcomes in COVID-19 patients with non-alcoholic fatty liver disease by severity of obesity: Insights from national inpatient sample 2020
Sashwath Srikanth, Vibhor Garg, Lakshmi Subramanian, Jyoti Verma, Hansika Sharma, Harroop Singh Klair, Shrenil A Kavathia, Jithin Kolli Teja, Nikhil Sai Vasireddy, Kumar Anmol, Dhanush Kolli, Shruti Sanjay Bodhankar, Sobya Hashmi, Shaylika Chauhan, Rupak Desai
Sashwath Srikanth, Lakshmi Subramanian, Department of Medicine, ECU Health Medical Center, Greenville, NC 27834, United States
Vibhor Garg, Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, United States
Jyoti Verma, Department of Medicine, North Alabama Medical Centre, Florence, AL 35630, United States
Hansika Sharma, Department of General Medicine, Gandhi Medical College, Secunderabad 500003, Telangana, India
Harroop Singh Klair, Shruti Sanjay Bodhankar, Department of Medicine, Government Medical College, Patiala 147001, Punjab, India
Shrenil A Kavathia, Department of Medicine, B.J. Medical College, Ahmedabad 380016, Gujarat, India
Jithin Kolli Teja, Department of Medicine, JSS Medical College, Mysore 570015, Karnataka, India
Nikhil Sai Vasireddy, Department of Internal Medicine, Gandhi Medical College, Secunderabad 500003, Telangana, India
Kumar Anmol, Dhanush Kolli, Department of Medicine, Kasturba Medical College, Manipal 575001, Karnataka, India
Sobya Hashmi, Clinical Extern, Department of Internal Medicine, Beaumont Hospital, Dearborn, MI 48124, United States
Shaylika Chauhan, Department of Internal Medicine, Geisinger Health System, Wilkes-Barre, PA 18702, United States
Rupak Desai, Independent Researcher, Atlanta, GA 30079, United States
Author contributions: Srikanth S and Desai R contributed to resources; Srikanth S, Garg V, Subramanian L, Verma J, Klair H, Kavathia S, Teja J, Vasireddy N, Kumar A, Dhanush K, Bodhankar S, Hashmi S, and Desai R contributed to writing-original draft; Garg V, Subramanian L, Verma J, Sharma H, Klair H, Kavathia S, Teja J, Vasireddy N, Kumar A, Dhanush K, Bodhankar S, Hashmi S, Chauhan S, and Desai R contributed to writing - review & editing; Srikanth S and Sharma H, and Desai R contributed to visualization; Sharma H and Chauhan S contributed to supervision; Chauhan S and Desai R contributed to conceptualization, methodology; Desai R contributed to software, formal analysis; All authors have read and approved the final manuscript.
Institutional review board statement: Not applicable, data is obtained from a publicly available data set, patient identifiers are not used.
Informed consent statement: Informed consent statement was not needed because the study was carried out on a publicly available data set without patient identifiers.
Conflict-of-interest statement: All authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shaylika Chauhan, FACP, MD, Clinical Assistant Professor (Honorary), Department of Internal Medicine, Geisinger Health System, 1000 E Mountain Blvd, Wilkes-Barre, PA 18702, United States. drshaylikachauhan@gmail.com
Received: January 3, 2024
Revised: March 15, 2024
Accepted: May 14, 2024
Published online: June 27, 2024
Processing time: 168 Days and 4.8 Hours
Abstract
BACKGROUND

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.

AIM

To study the in-hospital outcomes in COVID-19 patients with NAFLD by severity of obesity.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Keywords: Non-alcoholic fatty liver disease; Obesity; Obese; Body mass index; Major adverse cardiac and cerebrovascular events; Mortality; Acute myocardial infarction; Cardiac arrest; Stroke

Core Tip: Non-alcoholic fatty liver disease (NAFLD) has become a major cause of morbidity and mortality from liver disease and is the most common cause of chronic liver disease, with a global prevalence of 25% and a 50.4% increase in prevalence in the last three decades. To the best of our knowledge, this is the largest study investigating the comorbidities and outcomes of coronavirus disease 2019 hospitalizations with NAFLD and different levels of obesity.