Gowthami Sai K. Kogilathota Jagirdhar, MD1, Rakhtan Qasba, 2, Anna Flumignan, 3, Akshat Banga, MBBS4, Kaanthi Rama, 5, Shiva Teja Reddy, 5, Rahul Kashyap, MBBS, MBA6, Vikas Bansal, MBBS7, Yatinder Bains, MD8, Theodore DaCosta, MD, DO8 1Saint Michael's Medical Center, Newark, NJ; 2Green Life Medical College and Hospital, Dhaka, Dhaka, Bangladesh; 3Universidade Positivo, Curitiba, Parana, Brazil; 4Sawai Man Singh Medical College, Jaipur, Rajasthan, India; 5Gandhi Medical College, Hyderabad, Telangana, India; 6Keystone Health, Rochester, MN; 7Mayo Clinic, Rochester, MN; 8Saint Michael's Medical Center, New York Medical College, Newark, NJ
Introduction: With the ongoing SARS-CoV-2 pandemic there is a need to evaluate and investigate risk factors for COVID-19. Age, dyslipidemia, obesity, cardiovascular disease, and chronic kidney disease are established risk factors that lead to worse outcomes in COVID-19 Patients. The association between Non-Alcoholic fatty liver disease (NAFLD) and Metabolic Associated fatty liver disease (MAFLD) and COVID-19 infection is still in debate The discrepancies in the literature may be due to confounding factors, a small study population, and heterogeneity. We conducted a systematic review and meta-analysis to investigate the impact of NAFLD/MAFLD on the duration of hospital stay in COVID-19 patients.
Methods: A systematic review of literature databases Pubmed, Cochrane, Embase, Science Direct, and Web of Science was conducted from January 2022- to May 2022. Observational studies or clinical trials that studied hospital stay 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 were included. The protocol of the study was registered in Prospero (CRD42022313259) and PRISMA guidelines were followed (Figure 1). The meta-analysis was performed using RevMan software on studies for hospital length of stay. Mean differences were generated to describe the overall effect size using random effect models.
Results: A total of 4,381 patients from eight studies were included in the qualitative analysis. A total of 909 patients in the NAFLD group and 3472 patients in the Non-NAFLD group. A qualitative synthesis showed that the mean difference in the hospital length of stay was 2.49 days between the NAFLD and NON-NAFLD groups and a 95% Confidence interval (95%CI) of 0.96- 4.02. (Figure 2) I2 = 61%.This denotes on an average ~2.5 days additional hospital stay among NAFLD/MAFLD patients with COVID-19.
Discussion: Our meta-analysis suggests that NAFLD patients remain in the hospital for a longer period than NON-NAFLD patients. Fatty Liver disease is a risk factor that leads to increased severity of COVID-19 infection.
Figure: PRISMA Flowchart outlining the study search and Forest Plot, meta-analysis of Hospital length of stay in COVID-19 with Fatty Liver disease
Gowthami Sai Kogilathota Jagirdhar indicated no relevant financial relationships.
Rakhtan Qasba indicated no relevant financial relationships.
Anna Flumignan indicated no relevant financial relationships.
Akshat Banga indicated no relevant financial relationships.
Kaanthi Rama indicated no relevant financial relationships.
Shiva Teja Reddy indicated no relevant financial relationships.
Rahul Kashyap indicated no relevant financial relationships.
Vikas Bansal indicated no relevant financial relationships.
Yatinder Bains indicated no relevant financial relationships.
Theodore DaCosta indicated no relevant financial relationships.
Gowthami Sai K. Kogilathota Jagirdhar, MD1, Rakhtan Qasba, 2, Anna Flumignan, 3, Akshat Banga, MBBS4, Kaanthi Rama, 5, Shiva Teja Reddy, 5, Rahul Kashyap, MBBS, MBA6, Vikas Bansal, MBBS7, Yatinder Bains, MD8, Theodore DaCosta, MD, DO8. A0482 - Association of Non-Alcoholic Fatty Liver Disease and Metabolic-Associated Fatty Liver Disease with Duration of Hospital Stay in Covid-19 Patients: A Systematic Review and Meta-Analysis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.