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Risk of severe illness from COVID-19 in patients with metabolic dysfunction-associated fatty liver disease and increased fibrosis scores
  1. Giovanni Targher1,
  2. Alessandro Mantovani1,
  3. Christopher D Byrne2,
  4. Xiao-Bo Wang3,
  5. Hua-Dong Yan4,
  6. Qing-Feng Sun5,
  7. Ke-Hua Pan5,
  8. Kenneth I Zheng6,
  9. Yong-Ping Chen7,
  10. Mohammed Eslam8,
  11. Jacob George8,
  12. Ming-Hua Zheng6,9
  1. 1 Department of Medicine, Endocrinology and Metabolism, University of Verona, Verona, Veneto, Italy
  2. 2 Southampton National Institute for Health Research Biomedical Research Centre, Southampton General Hospital, Southampton, Hampshire, UK
  3. 3 Department of Critical Care Medicine, Wenzhou Medical College First Affiliated Hospital, Wenzhou, Zhejiang, China
  4. 4 Department of Hepatology, Ningbo No 2 Hospital, Ningbo, Zhejiang, China
  5. 5 Department of Radiology, Wenzhou Medical University First Affiliated Hospital, Wenzhou, Zhejiang, China
  6. 6 NAFLD Research Center, Department of Hepatology, Wenzhou Medical College First Affiliated Hospital, Wenzhou, Zhejiang, China
  7. 7 Department of Infection and Liver Diseases, Liver Research Center, Wenzhou Medical College First Affiliated Hospital, Wenzhou, Zhejiang, China
  8. 8 Storr Liver Centre, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
  9. 9 Institute of Hepatology, Wenzhou Medical University, Wenzhou, Zhejiang, China
  1. Correspondence to Professor Giovanni Targher, Department of Medicine, Endocrinology and Metabolism, University of Verona, Verona 37126, Italy; giovanni.targher{at}univr.it; Professor Ming-Hua Zheng, MAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, No 2 Fuxue Lane, Wenzhou 325000, China; zhengmh{at}wmu.edu.cn

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A recent study reported that patients with severe COVID-19 were more likely to have non-alcoholic fatty liver disease (NAFLD) compared with those with non-severe COVID-19 illness.1 However, the prognosis of NAFLD (recently renamed metabolic dysfunction-associated fatty liver disease (MAFLD)2) is determined by the severity of liver fibrosis.3 4 We therefore postulated that patients with MAFLD with increased non-invasive liver fibrosis scores are at higher risk of severe illness from COVID-19.

We studied 310 patients with laboratory-confirmed COVID-19 who were consecutively hospitalised at four sites in Zhejiang Province, China, between January and February 2020. Some of these patients (n=150) have been included in a prior study examining the association between obesity and COVID-19 severity.5 Patients with viral hepatitis, excessive alcohol consumption, chronic pulmonary diseases or active cancers were excluded. Clinical and laboratory data were collected at hospital admission. All patients were screened for hepatic steatosis by computed tomography and subsequently diagnosed as MAFLD.6 The originally validated cut-points for fibrosis-4 (FIB-4) index and NAFLD fibrosis score (NFS) were used to categorise liver fibrosis probability …

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