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A majority of long-COVID patients who had been hospitalized for severe COVID-19 illness had metabolic (dysfunction)-associated fatty liver disease (MAFLD), a retrospective study from Italy found.

In an analysis of 235 patients presenting to a post-acute COVID syndrome (PACS) clinic in Italy, 55.3% had MAFLD during follow-up as compared to 37.3% upon their initial hospital admission (P<0.001), reported Paolo Raggi, MD, of the University of Alberta in Edmonton, and colleagues.

"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-cluster phenotype, potentially affecting the metabolic and cardiovascular health of patients with PACS," the group wrote in .

On 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 researchers 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."

Raggi told 番茄社区app that while "a surprising number" of patients had an abnormal fatty liver in the study, the question is whether this was a manifestation of long-COVID.

In the study, 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," said Raggi.

"Many of the same risk factors for severe COVID-19 are those that would also be present in MAFLD -- obesity, cirrhosis, and a large number of comorbid medical conditions," said Andrew Talal, MD, MPH, of the University at Buffalo in New York, who was not involved in this study.

Also, "infections have previously been shown to provoke or accelerate development of MAFLD," he told 番茄社区app. "This report should definitely promote other studies to follow up on these observations."

The study authors suggested that "emphasizing physical activity and weight loss" could help patients with MAFLD and PACS.

For their study, Raggi and colleagues 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 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%).

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 analysis had several limitations, the researchers 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.

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