Implication of non-alcoholic fatty liver diseases (NAFLD) in patients with COVID-19: a preliminary analysis
NAFLD is present in 70-80% of patients with T2D. This study was a retrospective review of 202 consecutive patients admitted to two medical centers in China who had a confirmed diagnosis of COVID-19 and history of NAFLD. Despite the fact that over 75% of patients had some liver injury during their hospital course, most liver injury associated with COVID-19 was mild. Patients with higher BMI were more likely to have persistent liver injury. Patients with NAFLD had a higher risk of COVID-19 progression, higher likelihood of abnormal liver tests, and longer viral shedding than those without NAFLD although it was not clear where the comparison numbers were obtained from. Patients with higher BMIBased on a single post mortem liver biopsy, it was hypothesized that liver damage may be immune rather than directly cytopathic.
Summary of overall statistics for diabetes:
- Chronic hyperglycemia negatively affects immune function and increases the risk of morbidity and mortality due to any infection and is associated to organic complications. This is also the case for COVID-19 infection .
- Mortality is strongly increased with the presence of comorbid diseases, including previous cardiovascular disease (10.5%), diabetes (7.3%), chronic respiratory disease, hypertension, and cancer, each at 6%.
Recommendations for patients with diabetes:
- Social distancing.
- Ensure adequate stock of medications and supplies for monitoring blood glucose during the period of home confinement.
- Maintain good glycemic control.
- Routine appointments in person are not recommended for people with diabetes, as they should avoid crowds (waiting rooms).
- Phone calls, video calls, and emails should be the main way for patients to keep in touch with their healthcare provider team, in order to guarantee an optimal control of the disease.
- Implementation of “Sick day rules” is therefore mandatory to overcome potential diabetes decompensation.
Review of current knowledge.
- Diabetes mellitus has been associated with severity and death in patients with COVID-19.
- Chronic inflammation, increased coagulation activity, immune response impairment, and potential direct pancreatic damage by SARS-CoV-2 might be among the underlying pathophysiological mechanisms contributing to the increased morbidity and mortality of COVID-19 in people with diabetes.
- Clinical evidence does not support the discontinuation of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers in people with diabetes and COVID-19.
- Caution should be taken to avoid potential hypoglycemic events related to the use of chloroquine in people with diabetes and COVID-19.
- Glucose levels should be monitored rigorously, and dose adjustments of antidiabetic drugs may be necessary.
- Patient tailored therapeutic strategies, multidisciplinary team approaches and lower thresholds for hospitalization of patients with diabetes and COVID-19 may impact positively on their outcomes.