Metabolic surgery may protect against admission for COVID-19 in persons with nonalcoholic fatty liver disease

Abstract

Background Covid-19 disease causes significant morbidity and mortality through increase inflammation and thrombosis. Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are states of chronic inflammation and indicate advanced metabolic disease. The purpose of this observational study was to characterize the risk of hospitalization for Covid-19 in patients with NAFLD/NASH and evaluate the mitigating effect of various metabolic treatments. Methods Retrospective analysis of electronic medical record data of 26,896 adults from a 12-hospital Midwest healthcare system with a positive SARS-CoV-2 PCR from March 1, 2020 to Jan 26, 2021. Variable selection was guided by LASSO and multiple imputation was used to account for missing data. Multivariable logistic regression and competing risk models were used to assess odds of being hospitalized within 45 days of Covid-19 diagnosis. Analysis assessed the risk of hospitalization among patients with a prescription for metformin and statin use within the 3 months prior to the SARS-CoV-2 PCR result, history of home glucagon-like-peptide 1 receptor agonist (GLP-1 RA) use, and history of metabolic and bariatric surgery (MBS). Interactions were assessed by gender and race. Results A history of NAFLD/NASH was associated with increased odds of admission for Covid-19, (OR 1.88 95% CI 1.57-2.26, p<0.001)) and mortality (OR 1.96, 95% CI 1.45-2.67, p < 0.001). Each additional year of having NAFLD/NASH was associated with a significant increased risk of being hospitalized for Covid-19 (OR 1.24 95% CI 1.14-1.35, p<0.001). NAFLD/NASH increased risk of hospitalization in men, but not women, and increased risk of hospitalization in all non-white racial/ethnic subgroups. Medication treatments for metabolic syndrome were associated with significantly reduced risk of admission: OR 0.81 (0.67-0.99, p<0.001) for home metformin use and OR 0.71 (0.65-0.83, p<0.001) for home statin use. MBS was associated with a significant decreased risk of admission: OR 0.48 (0.33-0.69, p<0.001). Conclusions NAFLD/NASH is a significant risk factor for hospitalization for Covid-19, and appears to account for risk attributed to obesity. Other significant risks include factors associated with socioeconomic status and other comorbidities, such as history of venous thromboembolism. Treatments for metabolic disease mitigated risks from NAFLD/NASH. More research is needed to confirm risk associated with visceral adiposity, and patients should be screened for and informed of treatments for metabolic syndrome.

Impact of prior bariatric surgery on risk and severity of COVID-19 infection: A meta-analysis of observational studies

“…The study characteristics are described in Table 1 . Seven studies enrolled hospitalized or non-hospitalized patients with COVID-19 infection [21] , [22] , [29] , [30] , [31] , [32] , [33] , while four studies investigated the infection rate of COVID-19 in the outpatient setting during the pandemic [20] , [23] , [34] , [35] . To reduce potential bias, five studies were conducted with the matched-cohort design in which patients in the BS group were matched with those who did not have surgical intervention for their obesity (control group) [20] , [21] , [22] , [29] , [31] .…”

“…To reduce potential bias, five studies were conducted with the matched-cohort design in which patients in the BS group were matched with those who did not have surgical intervention for their obesity (control group) [20] , [21] , [22] , [29] , [31] . The other six studies included patients with obesity as the control group without matching their baseline characteristics (e.g., age, comorbidities) [23] , [30] , [32] , [33] , [34] , [35] . For the seven studies that provided BMI in both groups, the range of BMI was 31-41 and 39-45 kg/m 2 in the BS and control groups, respectively [20] , [21] , [23] , [29] , [31] , [34] , [35] .…”

“…Nine studies enrolled participants with age more than 18 years, while the other two recruited individuals with age more than 15 [30] and 16 [22] years. The eleven studies were conducted in five countries, including USA (six studies) [20] , [22] , [29] , [31] , [32] , [33] , France (two studies) [21] , [30] , Italy (one study) [34] , Iran (one study) [35] , and Brazil (one study) [23] . Based on NOS, 90.9% (10/11) of the comparative cohort studies exhibited an overall low risk of bias (i.e., total score ≥ 7) ( Supplemental Table 3 ).…”

“…Based on NOS, 90.9% (10/11) of the comparative cohort studies exhibited an overall low risk of bias (i.e., total score ≥ 7) ( Supplemental Table 3 ). The most common bias was the lack of confounding factor control in the comparability domain [22] , [23] , [30] , [32] , [33] , [34] , [35] .…”

“…A total of 151,113 patients were available for mortality analysis, which showed a lower risk of mortality in the BS group compared to the non-BS group (OR=0.42, 95%CI: 0.27 to 0.65, p <0.001; I 2 =67%) ( Fig. 1 ) [20] , [21] , [22] , [29] , [30] , [31] , [32] , [33] , [34] , [35] . Sensitivity analysis demonstrated no significant impact on outcome by omitting certain studies.…”