key: cord-0956841-dp4gvdli
authors: Ji, Dong; Cheng, Gregory; Lau, George
title: Reply to: ‘NAFLD is a predictor of liver injury in COVID-19 hospitalized patients but not of mortality, disease severity on the presentation or progression-The debate continues’
date: 2020-10-29
journal: J Hepatol
DOI: 10.1016/j.jhep.2020.10.020
sha: a8096dcc6f7fbc9c861601e38c14d091d80877e9
doc_id: 956841
cord_uid: dp4gvdli

nan

We read with interest the article by Mushtaq et al entitled "NAFLD is a predictor of liver injury in COVID-19 hospitalized patients but not of mortality, disease severity on the presentation or progression-The debate continues" (1). Both our (2) and their studies used similar inclusion criteria and the HSI index as a surrogate marker for the presence of NAFLD. We found that NAFLD is an independent predictor for disease progression. However, their study showed that when controlled for covariates in multivariate analysis, NAFLD was not a predictor of mortality, disease severity, or markers of disease progression. COVID-19 patients with pulmonary embolism at autopsies (4) . NAFLD patients had elevated plasma levels of von Willebrand factor and circulating plasminogen activator inhibitor type 1 (5) . The liver is a frontline immune organ and increased production of pro-inflammatory cytokines by adipose cells and Kupffer cells had been reported in NAFLD patients (6) . We had also observed that the mean admission and peak D-dimer levels were also significantly higher in COVID -19 patients with NAFLD than those without NAFLD, 0.72 ± 1.10 ug/ml vs 0.38 ± 0.46 ug/ml, p=0.003 and 1.81 ± 4.1mg/ml vs 0.63 ± 0.41mg/ml, p=0.003 respectively. Therefore, COVID-19 patients with underlying NAFLD may have higher likelihood of activation of the coagulation cascade by pro-inflammatory cytokines and subsequent thrombosis. This NAFLD associated hypercoagulable state may contribute to disease progression in COVID-19.

J o u r n a l P r e -p r o o f

NAFLD is a predictor of liver injury in COVID-19 hospitalized patients but not of mortality, disease severity on the presentation or progression-The debate continues

Non-alcoholic Fatty Liver Diseases in Patients With COVID-19: A Retrospective Study

Younger patients with MAFLD are at increased risk of severe COVID-19 illness: A multicenter preliminary analysis

Pulmonary Arterial Thrombosis in COVID-19 With Fatal Outcome:results from a prospective, single-center, clinicopathologic case series

Prothrombotic factors in histologically proven NAFLD and NASH

Role of cytokines and chemokines in non-alcoholic fatty liver disease