Advertisement

Reply to "Does MAFLD really increase the severity of COVID-19?"

Published:November 04, 2020DOI:https://doi.org/10.1016/j.dld.2020.10.034

      Keywords

      Dear Editor,
      We would like to thank Fajar et al. [
      • Fajar J.K.
      • Wibowo B.P.
      • Dewi G.C.
      • Rahmadi A.P.
      • Kusuma M.T.
      Does MAFLD really increase the severity of COVID-19?.
      ] for the appreciation and interest in our study, as well as the insightful comments and concerns. The Authors stress that our paper provided important information in the context of COVID-19 management, particularly in patients with MAFLD. At the same time, they raised some questions, the following points should be noted:
      First, there were not relatively enough studies investigating the association between MAFLD and severity of COVID-19, therefore we included these letters in our meta-analysis. The method used was supported by several published studies [
      • Hasani H.
      • Mardi S.
      • Shakerian S.
      • Taherzadeh-Ghahfarokhi N.
      • Mardi P.
      The novel coronavirus disease (COVID-19): a PRISMA systematic review and meta-analysis of clinical and paraclinical characteristics.
      ,
      • Gülsen A.
      • Yigitbas B.A.
      • Uslu B.
      • Drömann D.
      • Kilinc O.
      The effect of smoking on COVID-19 symptom severity: systematic review and meta-analysis.
      ,
      • Zheng Z.
      • Peng F.
      • Xu B.
      • Zhao J.
      • Liu H.
      • Peng J.
      • et al.
      Risk factors of critical & mortal COVID-19 cases: a systematic literature review and meta-analysis.
      ].
      Second, Zhou et al. and Targher et al. reported the number of COVID-19 co-exiting with MAFLD and the total COVID-19, which provided sufficient data to calculate the pooled prevalence of MAFLD among patients with COVID-19. The method of pooled analysis has been used in many high-quality publications in the literature [
      • Bedogni G.
      • Miglioli L.
      • Masutti F.
      • Tiribelli C.
      • Marchesini G.
      • Bellentani S.
      Prevalence of and risk factors for nonalcoholic fatty liver disease: the Dionysos nutrition and liver study.
      ,
      • Younossi Z.M.
      • Koenig A.B.
      • Abdelatif D.
      • Fazel Y.
      • Henry L.
      • Wymer M.
      Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes.
      ,
      • Zhou F.
      • Zhou J.
      • Wang W.
      • Zhang X.J.
      • Ji Y.X.
      • Zhang P.
      • et al.
      Unexpected rapid increase in the burden of NAFLD in China From 2008 to 2018: a systematic review and meta-analysis.
      ,
      • Zhou J.
      • Zhou F.
      • Wang W.
      • Zhang X.J.
      • Ji Y.X.
      • Zhang P.
      • et al.
      Epidemiological features of NAFLD from 1999 to 2018 in China.
      ].
      Third, the definition of COVID-19 severity in our meta-analysis was described in the section on method, according to the criteria listed in the Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (Trial Version 7). Targher et al. reported that MAFLD patients with neutrophil-tolymphocyte ratio (NLR) ≤ 2.8 were not associated with higher risk of severity of COVID-19 with adjusted odds ratio (5.32, 95%CI 0.98–29.90), in comparison to those without MAFLD and NLR ≤ 2.8. Since better data could not be obtained, thus we extracted the data in our pooled analysis for association between MAFLD and severity of COVID-19.

      Declaration of Competing Interest

      None declared.

      References

        • Fajar J.K.
        • Wibowo B.P.
        • Dewi G.C.
        • Rahmadi A.P.
        • Kusuma M.T.
        Does MAFLD really increase the severity of COVID-19?.
        Digestive liver disease. 2020; 52: 169-170
        • Hasani H.
        • Mardi S.
        • Shakerian S.
        • Taherzadeh-Ghahfarokhi N.
        • Mardi P.
        The novel coronavirus disease (COVID-19): a PRISMA systematic review and meta-analysis of clinical and paraclinical characteristics.
        Biomed Res Int. 2020; 20203149020
        • Gülsen A.
        • Yigitbas B.A.
        • Uslu B.
        • Drömann D.
        • Kilinc O.
        The effect of smoking on COVID-19 symptom severity: systematic review and meta-analysis.
        Pulm Med. 2020; 20207590207
        • Zheng Z.
        • Peng F.
        • Xu B.
        • Zhao J.
        • Liu H.
        • Peng J.
        • et al.
        Risk factors of critical & mortal COVID-19 cases: a systematic literature review and meta-analysis.
        J Infect. Aug 2020; 81 (e16–e25)
        • Bedogni G.
        • Miglioli L.
        • Masutti F.
        • Tiribelli C.
        • Marchesini G.
        • Bellentani S.
        Prevalence of and risk factors for nonalcoholic fatty liver disease: the Dionysos nutrition and liver study.
        Hepatology. Jul 2005; 42 (Baltimore, Md): 44-52
        • Younossi Z.M.
        • Koenig A.B.
        • Abdelatif D.
        • Fazel Y.
        • Henry L.
        • Wymer M.
        Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes.
        Hepatology. Jul 2016; 64 (Baltimore, Md): 73-84
        • Zhou F.
        • Zhou J.
        • Wang W.
        • Zhang X.J.
        • Ji Y.X.
        • Zhang P.
        • et al.
        Unexpected rapid increase in the burden of NAFLD in China From 2008 to 2018: a systematic review and meta-analysis.
        Hepatology. Oct 2019; 70 (Baltimore, Md): 1119-1133
        • Zhou J.
        • Zhou F.
        • Wang W.
        • Zhang X.J.
        • Ji Y.X.
        • Zhang P.
        • et al.
        Epidemiological features of NAFLD from 1999 to 2018 in China.
        Hepatology. May 2020; 71 (Baltimore, Md): 1851-1864

      Linked Article

      • Does MAFLD really increase the severity of COVID-19?
        Digestive and Liver DiseaseVol. 53Issue 2
        • Preview
          We read with great interest the meta-analysis by Pan et al [1] entitled “Metabolic associated fatty liver disease increases the severity of COVID-19” published in Digestive and Liver Disease. The article provides new information on the risk of severe COVID-19. There is evidence suggesting that comorbidities such as hypertension, diabetes mellitus, and cardiovascular diseases are associated with COVID-19 severity ( https://covid19.who.int/ ). In their article, the authors found that individuals with metabolic associated fatty liver disease (MAFLD) also have a high risk to develop a severe condition when infected by COVID-19, [odds ratio (OR): 2.93; 95% confidence interval (95%CI): 1.87, 4.60].
        • Full-Text
        • PDF