Clinical features of COVID‐19 patients with non‐alcoholic fatty liver disease

Huang, Rui; Zhu, Li; Wang, Jian; Xue, Leyang; Liu, Longgen; Yan, Xuebing; Huang, Songping; Li, Yang; Yan, Xiaomin; Zhang, Biao; Xu, Tianmin; Li, Chunyang; Ji, Fang; Ming, Fang; Zhao, Yun; Cheng, Juan; Wang, Yinling; Zhao, Haiyan; Hong, Shuqin; Chen, Kang; Zhao, Xiang‐an; Zou, Lei; Sang, Dawen; Shao, Huaping; Guan, Xinying; Chen, Xiaobing; Chen, Yuxin; Wei, Jie; Zhu, Chuanwu; Wu, Chao

BACKGROUND AND AIMS: Previous studies reported that coronavirus disease 2019 (COVID‐19) was likely to result in liver injury. However, few studies investigated liver injury in COVID‐19 patients with chronic liver diseases. We described the clinical features in COVID‐19 patients with non‐alcoholic fatty liver disease (NAFLD). METHODS: Confirmed COVID‐19 patients from hospitals in 10 cities of Jiangsu province, China were retrospectively included between January 18, 2020, and February 26, 2020. Hepatic Steatosis Index (HSI) was used to defined NAFLD. RESULTS: A total of 280 COVID‐19 patients were enrolled. Eighty‐six (30.7%) of 280 COVID‐19 patients were diagnosed as NAFLD by HSI. 100 (35.7%) patients presented abnormal liver function on admission. The median ALT levels (34.5 U/L vs. 23.0 U/L, P<0.001) and the proportion of elevated ALT (>40 U/L) (40.7% vs. 10.8%, P<0.001) were significantly higher in patients with NAFLD than in patients without NAFLD on admission. The proportion of elevated ALT in patients with NAFLD was also significantly higher than patients without NAFLD (65.1% vs. 38.7%, P<0.001) during hospitalization. Multivariate analysis showed that age over 50 years (odds ratio [OR] 2.077, 95% confidence interval [CI] 1.183‐3.648, P=0.011), and concurrent NAFLD (OR 2.956, 95% CI 1.526‐5.726, P=0.001) were independent risk factors of ALT elevation in COVID‐19 patients, while the atomized inhalation of interferon α‐2b (OR 0.402, 95%CI 0.236‐0.683, P=0.001) was associated with the reduced risk of ALT elevation during hospitalization. No patient developed liver failure or death during hospitalization. The complications and clinical outcomes were comparable between COVID‐19 patients with and without NAFLD. CONCLUSIONS: NAFLD patients are more likely to develop liver injury when infected by COVID‐19. However, no patient developed severe liver‐related complications during hospitalization.