Jeeyavudeen MS, Chaudhari R, Pappachan JM, Fouda S. Clinical implications of COVID-19 in patients with metabolic-associated fatty liver disease. World J Gastroenterol 2023; 29(3): 487-502 [PMID: 36688018 DOI: 10.3748/wjg.v29.i3.487]
Corresponding Author of This Article
Joseph M Pappachan, FRCP, MD, Consultant, Professor, Senior Editor, Senior Researcher, Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Sharoe Green Lane, Preston PR2 9HT, United Kingdom. drpappachan@yahoo.co.in
Research Domain of This Article
Infectious Diseases
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jan 21, 2023; 29(3): 487-502 Published online Jan 21, 2023. doi: 10.3748/wjg.v29.i3.487
Clinical implications of COVID-19 in patients with metabolic-associated fatty liver disease
Mohammad Sadiq Jeeyavudeen, Rahul Chaudhari, Joseph M Pappachan, Sherouk Fouda
Mohammad Sadiq Jeeyavudeen, Department of Endocrinology and Metabolism, University Hospitals of Edinburgh, Edinburgh EH4 2XU, United Kingdom
Rahul Chaudhari, Department of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA 23298, United States
Joseph M Pappachan, Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
Joseph M Pappachan, Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
Joseph M Pappachan, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, United Kingdom
Sherouk Fouda, School of Health and Biomedical Sciences, RMIT University, Melbourne VIC, Australia
Author contributions: Jeeyavudeen MS substantially contributed to the conception and design of the article, interpretation of relevant literature, article drafting, revision and figure preparation; Chaudhari R contributed to the interpretation of relevant literature, and article drafting; Pappachan JM and Fouda S contributed to the literature search and revision of the article critically for important intellectual content; All authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: All authors report having no relevant conflict of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Joseph M Pappachan, FRCP, MD, Consultant, Professor, Senior Editor, Senior Researcher, Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Sharoe Green Lane, Preston PR2 9HT, United Kingdom. drpappachan@yahoo.co.in
Received: September 12, 2022 Peer-review started: September 12, 2022 First decision: November 15, 2022 Revised: November 20, 2022 Accepted: December 27, 2022 Article in press: December 27, 2022 Published online: January 21, 2023
Abstract
People across the world are affected by the "coronavirus disease 2019 (COVID-19)", brought on by the "SARS-CoV type-2 coronavirus". Due to its high incidence in individuals with diabetes, metabolic syndrome, and metabolic-associated fatty liver disease (MAFLD), COVID-19 has gained much attention. The metabolic syndrome's hepatic manifestation, MAFLD, carries a significant risk of type-2-diabetes. The link between the above two conditions has also drawn increasing consideration since MAFLD is intricately linked to the obesity epidemic. Independent of the metabolic syndrome, MAFLD may impact the severity of the viral infections, including COVID-19 or may even be a risk factor. An important question is whether the present COVID-19 pandemic has been fueled by the obesity and MAFLD epidemics. Many liver markers are seen elevated in COVID-19. MAFLD patients with associated comorbid conditions like obesity, cardiovascular disease, renal disease, malignancy, hypertension, and old age are prone to develop severe disease. There is an urgent need for more studies to determine the link between the two conditions and whether it might account for racial differences in the mortality and morbidity rates linked to COVID-19. The role of innate and adaptive immunity alterations in MAFLD patients may influence the severity of COVID-19. This review investigates the implications of COVID-19 on liver injury and disease severity and vice-versa. We also addressed the severity of COVID-19 in patients with prior MAFLD and its potential implications and therapeutic administration in the clinical setting.
Core Tip: The severity of coronavirus disease 2019 (COVID-19) symptoms and sequelae positively correlate with high rates of hepatic decompensation and elevated transaminases in patients with chronic liver disease and cirrhosis. Implicated mechanisms linking cirrhosis with severe COVID-19 symptoms include cirrhosis-related immune dysregulation, systemic inflammation, coagulopathy, and metabolic derangements. Metabolic-associated fatty liver disease (MAFLD) is characterized as the hepatic manifestation of the metabolic syndrome and therefore is highly associated with other comorbidities such as obesity, diabetes, and hyperlipidemia. Those comorbidities are also risk factors for severe COVID-19. The hepatic distribution of the angiotensin-converting enzyme 2 receptor, the main viral entry receptor for SARS-CoV-2, may determine the severity of hepatic involvement. In addition, moderate hepatic dysfunction could alter the severity of COVID-19, as well as the safety profile, and the therapeutic efficacy of antiviral drugs metabolized in the liver. Therefore, it is of high clinical priority to enhance our understanding of COVID-19 infection-associated liver injury in MAFLD patients to treat both of these conditions effectively.
