Main clinical and biochemical characteristics of patients with laboratory-confirmed COVID-19, stratified by the presence or absence of imaging-defined MAFLD with increasing levels of FIB-4 score
| No MAFLD | MAFLD with low FIB-4 (≤1.3) | MAFLD with intermediate FIB-4 (1.3–2.67) | MAFLD with high FIB-4 (>2.67) | P value | |
| N | 216 | 44 | 36 | 14 | |
| Age (years) | 45.9±15.4 | 41.2±14.2 | 54.2±10.8 | 59.9±9.1 | <0.001 |
| Male sex (%) | 43.5 | 54.6 | 63.9 | 57.1 | 0.086 |
| BMI (kg/m2) | 23.0±3.2 | 26.5±4.7 | 26.6±3.2 | 26.1±2.8 | <0.001 |
| Obesity (%) | 25.9 | 61.4 | 75.0 | 64.3 | <0.001 |
| Current smokers (%) | 8.8 | 2.3 | 11.1 | 7.1 | 0.768 |
| Systolic blood pressure (mm Hg) | 130±17 | 136±15 | 136±16 | 136±14 | 0.047 |
| Diastolic blood pressure (mm Hg) | 80±11 | 84±11 | 82±11 | 79±8 | 0.117 |
| Prior diabetes (%) | 7.4 | 20.4 | 13.9 | 28.6 | 0.010 |
| White blood count (×109/L) | 4.90 (3.9–6.2) | 5.35 (4.5–6.7) | 4.69 (3.8–6.6) | 4.90 (3.2–5.8) | 0.254 |
| Neutrophil count (×109/L) | 3.05 (2.2–4.1) | 3.49 (2.6–4.2) | 3.0 (2.4–4.7) | 3.20 (1.9–4.5) | 0.759 |
| Lymphocyte count (×109/L) | 1.20 (0.9–1.6) | 1.40 (1.2–2.0) | 1.10 (0.7–1.3) | 0.92 (0.7–1.14) | <0.001 |
| Haemoglobin (g/L) | 132.4±16 | 136.6±15 | 135.5±12 | 135.8±17 | 0.305 |
| Platelet count (×100 000/mm3) | 211±72 | 246±75 | 183±64 | 125±24 | <0.001 |
| Prothrombin time (s), n=211 | 12.1±1.3 | 11.9±2.3 | 12.2±1.2 | 12.3±1.1 | 0.754 |
| APTT (s), n=211 | 31.5±3.8 | 32.7±5.4 | 32.8±3.7 | 35.3±7.4 | 0.026 |
| D-dimer (mg/L), n=183 | 0.18 (0.11–0.29) | 0.21 (0.1–0.5) | 0.21 (0.1–0.4) | 0.27 (0.1–0.4) | 0.432 |
| C reactive protein (mg/L) | 7.9 (1.9–24.9) | 8.6 (2.9–23.6) | 25.4 (8.7–53.3) | 25.5 (8.7–53.4) | <0.001 |
| Procalcitonin (ng/mL), n=190 | 0.05 (0.03–0.25) | 0.08 (0.04–0.25) | 0.06 (0.04–0.10) | 0.20 (0.08–0.25) | 0.077 |
| Albumin (g/L), n=286 | 41.4 (38.0–44.5) | 42.3 (37.3–44.6) | 41.0 (36.9–43.1) | 38.6 (37.7–42.8) | 0.348 |
| Total bilirubin (μmol/L) | 10.5 (7.0–15.5) | 10.1 (7.5–15.6) | 12.0 (9.5–16.6) | 15.3 (11.8–17.3) | 0.025 |
| AST (IU/L) | 22 (17–27) | 23 (19–32) | 32 (26–50) | 44 (29–83) | <0.001 |
| ALT (IU/L) | 18 (13–27) | 30 (22–52) | 28 (22–48) | 27 (16–82) | <0.001 |
| GGT (IU/L) | 21 (14–33) | 31 (22–54) | 51 (24–81) | 49 (32–102) | <0.001 |
| Elevated AST>40 IU/L (%) | 7.9 | 9.1 | 27.8 | 57.1 | <0.001 |
| Elevated ALT >40 IU/L (%) | 13.0 | 29.6 | 30.6 | 42.9 | <0.001 |
| Total cholesterol (mmol/L) | 3.98±0.8 | 4.11±0.9 | 3.73±0.7 | 3.82±1.0 | 0.217 |
| Triglycerides (mmol/L) | 1.15 (0.9–1.7) | 1.61 (1.0–2.1) | 1.48 (1.1–1.8) | 1.11 (0.9–1.6) | <0.005 |
| HDL cholesterol (mmol/L) | 1.18±0.4 | 0.96±0.2 | 1.06±0.2 | 1.09±0.4 | <0.005 |
| LDL cholesterol (mmol/L) | 2.23±0.7 | 2.54±0.8 | 2.10±0.7 | 2.20±0.8 | 0.116 |
| Hospital stay (days) | 18 (13–24) | 18 (13–22) | 22 (16–29) | 17 (6–23) | 0.122 |
| NAFLD fibrosis score, n=286 | −1.82 (−2.8 to −1.0) | −2.61 (−3.1 to −1.9) | −0.68 (−1.4 to −0.2) | +0.26 (−0.03 to 1.6) | <0.005 |
| COVID-19 severity | <0.001 | ||||
| Non-severe (%) | 88.4 | 86.4 | 63.9 | 57.1 | |
| Severe (%) | 11.6 | 13.6 | 36.1 | 42.9 |
Sample size, n=310, except where indicated. Diabetes was diagnosed as self-reported history of disease and/or specific drug treatment. Obesity was diagnosed as BMI>25 kg/m2. Data are expressed as means±SD, medians and IQRs (in parentheses) or frequencies. Differences among the four groups of patients were tested by Fisher’s exact test for categorical variables, one-way analysis of variance for normally distributed continuous variables or the Kruskal-Wallis test for not normally distributed continuous variables. For the sake of clarity, significant p values are highlighted in bold.
ALT, alanine aminotransferase; APTT, activated partial thromboplastin time; AST, aspartate aminotransferase; BMI, body mass index; FIB-4, fibrosis-4; GGT, gamma-glutamyltransferase; HDL, high-density lipoprotein cholesterol; LDL, low-density lipoprotein cholesterol; MAFLD, metabolic dysfunction-associated fatty liver disease; NAFLD, non-alcoholic fatty liver disease.