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Metabolic surgery may protect against admission for COVID-19 in persons with nonalcoholic fatty liver disease
BACKGROUND: SARS-CoV-2 (COVID-19) disease causes significant morbidity and mortality through increased inflammation and thrombosis. Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are states of chronic inflammation and indicate advanced metabolic disease. OBJECTIVE:...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Published by Elsevier Inc. on behalf of American Society for Bariatric Surgery.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8238640/ https://www.ncbi.nlm.nih.gov/pubmed/34326020 http://dx.doi.org/10.1016/j.soard.2021.05.029 |
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author | Tignanelli, Christopher J. Bramante, Carolyn T. Dutta, Nirjhar Tamariz, Leonardo Usher, Michael G. Ikramuddin, Sayeed |
author_facet | Tignanelli, Christopher J. Bramante, Carolyn T. Dutta, Nirjhar Tamariz, Leonardo Usher, Michael G. Ikramuddin, Sayeed |
author_sort | Tignanelli, Christopher J. |
collection | PubMed |
description | BACKGROUND: SARS-CoV-2 (COVID-19) disease causes significant morbidity and mortality through increased inflammation and thrombosis. Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are states of chronic inflammation and indicate advanced metabolic disease. OBJECTIVE: The purpose of this observational study was to characterize the risk of hospitalization for COVID-19 in patients with NAFLD/NASH and evaluate the mitigating effect of various metabolic treatments. SETTING: Retrospective analysis of electronic medical record data of 26,896 adults from a 12-hospital Midwest healthcare system with a positive COVID-19 polymerase chain reaction (PCR) test from March 1, 2020, to January 26, 2021. METHODS: Variable selection was guided by the least absolute shrinkage and selection operator (LASSO) method, and multiple imputation was used to account for missing data. Multivariable logistic regression and competing risk models were used to assess the odds of being hospitalized within 45 days of a COVID-19 diagnosis. Analysis assessed the risk of hospitalization among patients with a prescription for metformin and statin use within the 3 months prior to the COVID-19 PCR result, history of home glucagon-like peptide 1 receptor agonist (GLP-1 RA) use, and history of metabolic and bariatric surgery (MBS). Interactions were assessed by sex and race. RESULTS: A history of NAFLD/NASH was associated with increased odds of admission for COVID-19 (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.57–2.26; P < .001) and mortality (OR, 1.96; 95% CI, 1.45–2.67; P < .001). Each additional year of having NAFLD/NASH was associated with a significant increased risk of being hospitalized for COVID-19 (OR, 1.24; 95% CI, 1.14–1.35; P < .001). NAFLD/NASH increased the risk of hospitalization in men, but not women, and increased the risk of hospitalization in all multiracial/multiethnic subgroups. Medication treatments for metabolic syndrome were associated with significantly reduced risk of admission (OR, .81; 95% CI, .67–.99; P < .001 for home metformin use; OR, .71; 95% CI, .65–.83; P < .001 for home statin use). MBS was associated with a significant decreased risk of admission (OR, .48; 95% CI, .33–.69; P < .001). CONCLUSIONS: NAFLD/NASH is a significant risk factor for hospitalization for COVID-19 and appears to account for risk attributed to obesity. Other significant risks include factors associated with socioeconomic status and other co-morbidities, such as history of venous thromboembolism. Treatments for metabolic disease mitigated risks from NAFLD/NASH. More research is needed to confirm the risk associated with visceral adiposity, and patients should be screened for and informed of treatments for metabolic syndrome. |
format | Online Article Text |
id | pubmed-8238640 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Published by Elsevier Inc. on behalf of American Society for Bariatric Surgery. |
record_format | MEDLINE/PubMed |
spelling | pubmed-82386402021-06-29 Metabolic surgery may protect against admission for COVID-19 in persons with nonalcoholic fatty liver disease Tignanelli, Christopher J. Bramante, Carolyn T. Dutta, Nirjhar Tamariz, Leonardo Usher, Michael G. Ikramuddin, Sayeed Surg Obes Relat Dis Original Article BACKGROUND: SARS-CoV-2 (COVID-19) disease causes significant morbidity and mortality through increased inflammation and thrombosis. Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are states of chronic inflammation and indicate advanced metabolic disease. OBJECTIVE: The purpose of this observational study was to characterize the risk of hospitalization for COVID-19 in patients with NAFLD/NASH and evaluate the mitigating effect of various metabolic treatments. SETTING: Retrospective analysis of electronic medical record data of 26,896 adults from a 12-hospital Midwest healthcare system with a positive COVID-19 polymerase chain reaction (PCR) test from March 1, 2020, to January 26, 2021. METHODS: Variable selection was guided by the least absolute shrinkage and selection operator (LASSO) method, and multiple imputation was used to account for missing data. Multivariable logistic regression and competing risk models were used to assess the odds of being hospitalized within 45 days of a COVID-19 diagnosis. Analysis assessed the risk of hospitalization among patients with a prescription for metformin and statin use within the 3 months prior to the COVID-19 PCR result, history of home glucagon-like peptide 1 receptor agonist (GLP-1 RA) use, and history of metabolic and bariatric surgery (MBS). Interactions were assessed by sex and race. RESULTS: A history of NAFLD/NASH was associated with increased odds of admission for COVID-19 (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.57–2.26; P < .001) and mortality (OR, 1.96; 95% CI, 1.45–2.67; P < .001). Each additional year of having NAFLD/NASH was associated with a significant increased risk of being hospitalized for COVID-19 (OR, 1.24; 95% CI, 1.14–1.35; P < .001). NAFLD/NASH increased the risk of hospitalization in men, but not women, and increased the risk of hospitalization in all multiracial/multiethnic subgroups. Medication treatments for metabolic syndrome were associated with significantly reduced risk of admission (OR, .81; 95% CI, .67–.99; P < .001 for home metformin use; OR, .71; 95% CI, .65–.83; P < .001 for home statin use). MBS was associated with a significant decreased risk of admission (OR, .48; 95% CI, .33–.69; P < .001). CONCLUSIONS: NAFLD/NASH is a significant risk factor for hospitalization for COVID-19 and appears to account for risk attributed to obesity. Other significant risks include factors associated with socioeconomic status and other co-morbidities, such as history of venous thromboembolism. Treatments for metabolic disease mitigated risks from NAFLD/NASH. More research is needed to confirm the risk associated with visceral adiposity, and patients should be screened for and informed of treatments for metabolic syndrome. Published by Elsevier Inc. on behalf of American Society for Bariatric Surgery. 2021-10 2021-06-29 /pmc/articles/PMC8238640/ /pubmed/34326020 http://dx.doi.org/10.1016/j.soard.2021.05.029 Text en © 2021 Published by Elsevier Inc. on behalf of American Society for Bariatric Surgery. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Original Article Tignanelli, Christopher J. Bramante, Carolyn T. Dutta, Nirjhar Tamariz, Leonardo Usher, Michael G. Ikramuddin, Sayeed Metabolic surgery may protect against admission for COVID-19 in persons with nonalcoholic fatty liver disease |
title | Metabolic surgery may protect against admission for COVID-19 in persons with nonalcoholic fatty liver disease |
title_full | Metabolic surgery may protect against admission for COVID-19 in persons with nonalcoholic fatty liver disease |
title_fullStr | Metabolic surgery may protect against admission for COVID-19 in persons with nonalcoholic fatty liver disease |
title_full_unstemmed | Metabolic surgery may protect against admission for COVID-19 in persons with nonalcoholic fatty liver disease |
title_short | Metabolic surgery may protect against admission for COVID-19 in persons with nonalcoholic fatty liver disease |
title_sort | metabolic surgery may protect against admission for covid-19 in persons with nonalcoholic fatty liver disease |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8238640/ https://www.ncbi.nlm.nih.gov/pubmed/34326020 http://dx.doi.org/10.1016/j.soard.2021.05.029 |
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