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©The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2026; 18(2): 113004
Published online Feb 27, 2026. doi: 10.4254/wjh.v18.i2.113004
Published online Feb 27, 2026. doi: 10.4254/wjh.v18.i2.113004
Dynamic immune response and its influencing factors in COVID-19 patients with non-alcoholic fatty liver disease: A cohort study
Pan Yan, School of Public Health, Chengdu Medical College, Chengdu 610500, Sichuan Province, China
Pan Yan, Rui Li, Xiao-Yan Yuan, Yong Wang, Li-Juan Lan, Da-Feng Liu, The First Ward of Internal Medicine, Public Health Clinical Center of Chengdu, Chengdu 610060, Sichuan Province, China
Xiao-Ping Yu, School of Preclinical Medicine, Chengdu University, Chengdu 610106, Sichuan Province, China
Co-first authors: Pan Yan and Rui Li.
Co-corresponding authors: Xiao-Ping Yu and Da-Feng Liu.
Author contributions: Yan P and Li R contributed equally to this manuscript as co-first authors; Yan P and Liu DF designed the research study; Yu XP and Liu DF supervised the study and made equal contributions as co-corresponding authors; Yan P, Li R, Yuan XY, Wang Y, Lan LJ, Yu XP, and Liu DF acquired the data, analyzed and interpreted the data, drafted the manuscript, and provided administrative, technical, or material support. All authors approved the final manuscript.
Supported by Chengdu Science and Technology Bureau, No. 2021-YF05-00536-SN.
Institutional review board statement: This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Ethical approval for this research was obtained from the Ethics Committee of the Public Health Clinical Center of Chengdu (No. PJ-K2020-26-01).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: All data used in this study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Da-Feng Liu, The First Ward of Internal Medicine, Public Health Clinical Center of Chengdu, No. 377 Jingming Road, Jinjiang District, Chengdu 610060, Sichuan Province, China. ldf312@126.com
Received: August 12, 2025
Revised: September 25, 2025
Accepted: December 8, 2025
Published online: February 27, 2026
Processing time: 184 Days and 8.3 Hours
Revised: September 25, 2025
Accepted: December 8, 2025
Published online: February 27, 2026
Processing time: 184 Days and 8.3 Hours
Core Tip
Core Tip: This study reveals that coronavirus disease 2019 patients with non-alcoholic fatty liver disease (NAFLD) exhibit prolonged immune imbalance. Key risk factors—including age ≥ 60 years, significant liver fibrosis, multimorbidity (≥ 3 conditions), obesity, elevated liver enzymes, elevated low-density lipoprotein cholesterol, and elevated hemoglobin A1c—worsen immune imbalance. Notably, even lean NAFLD patients show persistent immune disturbances. These findings highlight the need for tailored clinical monitoring in coronavirus disease 2019-NAFLD patients, particularly for older adults, those with metabolic dysfunction, or those with advanced liver disease, to mitigate long-term immunological complications.