Retrospective analysis of electronic medical record data of 6,700 adults with a positive SARS-CoV-2 PCR from March 1, 2020 to Aug 25, 2020. Logistic regression and competing risk were used to assess odds of being hospitalized. Additional adjustment was added to assess risk of hospitalization among patients with a prescription for
metformin use within the 3 months prior to the SARS-CoV-2 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 gender and race.
Results: A history of
NAFLD/NASH was associated with increased odds of admission for
Covid-19: logistic regression OR 2.04 (1.55, 2.96, p<0.01), competing risks OR 1.43 (1.09-1.88, p<0.01); and each additional year of having
NAFLD/NASH was associated with a significant increased risk of being hospitalized for
Covid-19, OR 1.86 (1.43-2.42, p<0.01). After controlling for
NAFLD/NASH, persons with
obesity had decreased odds of hospitalization for
Covid-19, OR 0.41 (0.34-0.49, p<0.01).
NAFLD/NASH increased risk of hospitalization in men and women, and in all racial/ethnic subgroups. Mediation treatments for
metabolic syndrome were associated with non-significant reduced risk of admission: OR 0.42 (0.18-1.01, p=0.05) for home
metformin use and OR 0.40 (0.14-1.17, p=0.10) for home GLP-1RA use. MBS was associated with a significant decreased risk of admission: OR 0.22 (0.05-0.98, p<0.05).
Conclusions:
NAFLD/NASH is a significant risk factor for hospitalization for
Covid-19, and appears to account for risk attributed to
obesity. Treatments for
metabolic disease mitigated risks from
NAFLD/NASH. More research is needed to confirm risk associated with visceral adiposity, and patients should be screened for and informed of treatments for
metabolic syndrome.