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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Impact of metabolic dysfunction-associated steatotic liver disease on COVID-19 hospitalizations: A propensity-matched analysis of the United States
Abdullah Sohail, Hassam Ali, Pratik Patel, Subanandhini Subramanium, Dushyant Singh Dahiya, Amir H Sohail, Manesh Kumar Gangwani, Sanjaya K Satapathy
Abdullah Sohail, Department of Internal Medicine, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa, IA 52242, United States
Hassam Ali, Division of Gastroenterology and Hepatology, East Carolina University/Brody School of Medicine, Greenville, NC 27858, United States
Pratik Patel, Department of Gastroenterology, Mather Hospital/Hofstra University Zucker School of Medicine, NY, 11777, United States
Subanandhini Subramanium, Department of Internal Medicine, East Carolina University Brody School of Medicine, Greenville, NC 27834, United States
Dushyant Singh Dahiya, Division of Gastroenterology, Hepatology & Motility, The University of Kansas School of Medicine, Kansas City, KS 66160, United States
Amir H Sohail, Department of Surgery, University of New Mexico, Albuquerque, NM 87106, United States
Manesh Kumar Gangwani, Department of Internal Medicine, The University of Toledo, Toledo, OH 43606, United States
Sanjaya K Satapathy, Section on Gastroenterology and Hepatology, North Shore University Hospital and Long Island Jewish Medical Center, Manhasset, NY 11030, United States
Author contributions: Sohail A, Ali H, Patel P, Dahiya DS, and Sohail AH were involved in the study's conception, design, data collection, results interpretation, initial drafting, and substantial revisions for the manuscript's intellectual content; Gangwani MK and Subramanium S played key roles in analyzing data, interpreting findings, and contributing to the manuscript's draft; Satapathy SK provided significant manuscript enhancements through thoughtful revisions and relevant suggestions; Furthermore, all authors engaged in a review, modification, and final approval of the manuscript, ensuring responsibility for every aspect of the work.
Institutional review board statement: The National Inpatient Sample is an anonymized database at the hospital level managed by a third party. It is specifically designed to maintain the confidentiality of patients, healthcare providers, and medical institutions. Since the data related to hospitalizations is devoid of any personal identifiers of patients, the requirement for patient consent was exempted from this study. Additionally, the nature of this de-identified data negated the need for approval from an institutional review board.
Informed consent statement: The National Inpatient Sample is an anonymized database at the hospital level, managed by a third party. It is specifically designed to maintain the confidentiality of patients, healthcare providers, and medical institutions. Since the data related to hospitalizations is devoid of any personal identifiers of patients, the requirement for patient consent was exempted for this study.
Conflict-of-interest statement: Conflict of Interest Statement: The authors of this article declare that they have no conflict of interest to report. None of the authors have received any fees for serving as speakers, consultants, or advisory board members for any organizations. There has been no receipt of research funding from any organizations. Additionally, none of the authors are employees of any organizations that may have an interest in the subject matter of this study.
Data sharing statement: Not available.
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: Abdullah Sohail, MD, Assistant Professor, Internal Medicine, University of Iowa Roy J and Lucille A Carver College of Medicine, 200 Hawkins Dr, Iowa, IA 52242, United States.
abdullahsohailmd@gmail.com
Received: December 24, 2023
Peer-review started: December 24, 2023
First decision: January 11, 2024
Revised: January 2, 2024
Accepted: February 6, 2024
Article in press: February 6, 2024
Published online: March 25, 2024
Processing time: 78 Days and 9.3 Hours
BACKGROUND
Metabolic dysfunction-associated steatotic liver disease (MASLD), formally known as nonalcoholic fatty liver disease, is the most common chronic liver disease in the United States. Patients with MASLD have been reported to be at a higher risk of developing severe coronavirus disease 2019 (COVID-19) and death. However, most studies are single-center studies, and nationwide data in the United States is lacking.
AIM
To study the influence of MASLD on COVID-19 hospitalizations during the initial phase of the pandemic.
METHODS
We retrospectively analyzed the 2020 National Inpatient Sample (NIS) database to identify primary COVID-19 hospitalizations based on an underlying diagnosis of MASLD. A matched comparison cohort of COVID-19 hospitalizations without MASLD was identified from NIS after 1: N propensity score matching based on gender, race, and comorbidities, including hypertension, heart failure, diabetes, and cirrhosis. The primary outcomes included inpatient mortality, length of stay, and hospitalization costs. Secondary outcomes included the prevalence of systemic complications.
RESULTS
A total of 2210 hospitalizations with MASLD were matched to 2210 hospitalizations without MASLD, with a good comorbidity balance. Overall, there was a higher prevalence of severe disease with more intensive care unit admissions (9.5% vs 7.2%, P = 0.007), mechanical ventilation (7.2% vs 5.7%, P = 0.03), and septic shock (5.2% vs 2.7%, P <0.001) in the MASLD cohort than in the non-MASLD cohort. However, there was no difference in mortality (8.6% vs 10%, P = 0.49), length of stay (5 d vs 5 d, P = 0.25), and hospitalization costs (42081.5 $ vs 38614$, P = 0.15) between the MASLD and non-MASLD cohorts.
CONCLUSION
The presence of MAFLD with or without liver cirrhosis was not associated with increased mortality in COVID-19 hospitalizations; however, there was an increased incidence of severe COVID-19 infection. This data (2020) predates the availability of COVID-19 vaccines, and many MASLD patients have since been vaccinated. It will be interesting to see if these trends are present in the subsequent years of the pandemic.
Core Tip: This comprehensive study investigates the impact of metabolic dysfunction-associated steatotic liver disease (MASLD) on the severity of coronavirus disease 2019 (COVID-19) during the early stages of the pandemic, using the 2020 National Inpatient Sample database. It uniquely contrasts COVID-19 hospitalizations with and without MASLD, revealing that while MASLD is not linked to increased mortality, however, it is associated with a heightened risk of severe COVID-19 complications. This pivotal research offers valuable insights into the MASLD-COVID-19 relationship before the widespread availability of vaccines, setting the stage for further exploration into how these trends evolved in the later pandemic years.
