Non-alcoholic fatty liver disease as a leading metabolic risk factor for severe COVID-19: a gender analysis

Objective. To evaluate the sex-related association between non-alcoholic fatty liver disease (NAFLD) and COVID-19 severity, and to assess the impact of metabolic syndrome components on the risk of severe disease. Materials and methods. A retrospective analysis was conducted on 105 patients hospitalized with COVID-19 at the Bukhara Regional Infectious Diseases Hospital between September 2020 and September 2022. The diagnosis of non-alcoholic fatty liver disease (NAFLD) was established based on computed tomography (CT) or medical history. The study group included 55 patients with COVID-19 and NAFLD, while 50 patients with COVID-19 without NAFLD served as the control group. Multivariate logistic regression analysis was performed to evaluate predictors of severe COVID-19, adjusting for age, sex, body mass index (BMI), smoking, and components of metabolic syndrome. Results. Severe COVID-19 occurred significantly more often in patients with NAFLD compared to those without NAFLD (34.5 vs. 18.0 %; p = 0.001). NAFLD and smoking were identified as the strongest independent predictors of severe disease. Women with NAFLD exhibited a higher risk of severe COVID-19 (odds ratio (OR) 4.17; 95 % CI 4.08–4.58; p = 0.001) compared to men (OR 3.18; 95 % CI 3.10–3.69; p = 0.004), whereas type 2 diabetes mellitus (T2DM) had minimal impact on this risk in women compared to men (OR 0.95; 95 % CI 0.84–1.09; p = 0.04). Obesity and metabolic syndrome were also independent predictors of severe disease in both sexes. Conclusions. NAFLD is an independent risk factor for severe COVID-19 in both sexes, with a more pronounced risk in women. These findings underscore the importance of a comprehensive management approach for patients with COVID-19 that considers underlying NAFLD and metabolic abnormalities. Further large-scale prospective studies are needed to clarify the mechanisms underlying this association.

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