Features of the course of non-alcoholic fatty liver disease after COVID-19

Objective: to assess the effect of COVID-19 on the progression of NAFLD.

Materials and methods: a retrospective cohort study included 73 patients with NAFLD, of whom 22 had COVID-19 between March 2020 and February 2021. The diagnosis of NAFLD was established on the basis of clinical, laboratory and instrumental data. Anthropometric parameters, indicators of lipid and carbohydrate metabolism, markers of liver damage and systemic inflammation were evaluated. Transient elastography was used to determine the stage of liver fibrosis. 

Results: in patients with NAFLD who underwent COVID-19, there was a significant increase in body mass index (BMI) by 1.8 ± 0.9 kg/m² (p<0.001) and waist circumference by 4.3 ± 2.1 cm (p<0.001) compared with baseline values. At the same time, in the control group, the increase in BMI was only 0.4 ± 0.6 kg/m² (p= 0.132), and FROM — 1.1 ± 1.4 cm (p=0.083). The differences in the dynamics of anthropometric parameters between the main and control groups were statistically significant (p<0.001). ALT and AST levels in the group of patients with COVID-19 were higher than in the control group by 32.4% (p=0.002) and 28.7% (p=0.007), respectively. HOMA-IR and triglyceride indices also showed a statistically significant increase, compared with baseline data, by 38.6% (p<0.001) and 21.9% (p=0.011). The proportion of patients with liver fibrosis progression at stage 1 was 29.6% in the COVID-19 group versus 12.4% in the control group (HR=2.93; 95% CI: 1.76-4.88; p<0.001). Multivariate analysis showed that the severity of COVID-19 (HR=2.17; 95% CI: 1.24-3.79; p=0.006) and the initial stage of fibrosis (HR=1.84; 95% CI: 1.11-3.05; p=0.018) are independent predictors of NAFLD progression. 

Conclusion: The study demonstrated a significant impact of previous COVID-19 coronavirus infection on the course of NAFLD

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