S1265 Association of Non-Alcoholic Fatty Liver Disease and Metabolic-Associated Fatty Liver Disease with Mortality in COVID-19 Patients: A Systematic Review and Meta-Analysis

Abstract

Introduction: Current Literature shows that risk factors like obesity, diabetes, and hypertension which are components of metabolic syndrome lead to worse outcomes in COVID-19 Patients. Metabolicassociated fatty liver disease (MAFLD) is a hepatic manifestation of metabolic syndrome. Non-alcoholic fatty liver disease (NAFLD) and MAFLD like Obesity, these liver diseases are on the rise and are currently estimated to affect around 25% of the US population. This Meta-analysis aims to investigate the association between NAFLD and MAFLD and mortality outcomes among COVID-19 Patients. Methods: Systematic review of literature databases Pubmed, Cochrane, Embase, Science Direct, and Web of Science was conducted from Jan 2020 to May 2022. Observational studies or clinical trials that studied mortality outcomes in COVID-19 patients were included. Studies that assessed NAFLD/MAFLD using lab assessment (FIB-4, APRI, FIBROSIS score, HSI index, etc), non-invasive imaging (Elastography, Liver Ultrasound or CT scan, MR elastography, Liver stiffness measurement), or liver biopsy was included. The protocol of the study was registered in Prospero (CRD42022313259) and PRISMA guidelines were followed. (Figure ) Meta-analysis was performed on studies with mortality outcomes using RevMan software. Mantel-Haenszel odds ratio was generated to describe the overall effect size using random effect models. Results: A total of 37,724 patients from 20 studies were included in the qualitative analysis. A total of 1521 patients with COVID-19 died; 408 (9%) in the NAFLD group and 1113 (3.35%) in the non-NAFLD group. The odds ratio was 1.17 for mortality, p50.50 and a 95% Confidence interval (95% CI) of 0.74-1.86, I2 5 88% (Figure). We failed to observe an association between NAFLD/ MAFLD and hospital mortality among COVID-19 patients. Conclusion: Our Meta-analysis suggests that there is an increased odds of mortality among COVID-19 patients, which did not reach statistical significance. A high level of heterogeneity among the studies needs to be considered for future studies.