The Association of Metabolic-associated Fatty Liver Disease with Clinical Outcomes of COVID-19: A Systematic Review and Meta-Analysis

MAFLD and COVID-19 clinical outcomes


  • Umar Hayat, M.D., MPH University of Kansas
  • Muhammad Zubair Ashfaq, M.D.
  • Luke Johnson, M.D.
  • Ryan Ford, M.D.
  • Chelsea Wuthnow, M.D.
  • Kevin Kadado, M.D.
  • Katia El Jurdi, M.D.
  • Hayrettin Okut, Ph.D.
  • William Ransom Kilgore, M.D.
  • Maha Assi, M.D.
  • Ali A. Siddiqui, M.D.



Keywords: Metabolic-associated fatty liver disease; Severe acute respiratory syndrome coronavirus-2; COVID-19; Odds ratios; Meta-analysis; COVID-19 prevalence.


Introduction. Metabolic-associated fatty liver disease (MAFLD) is a hepatic manifestation of metabolic syndrome (MS). MAFLD patients have a higher prevalence of COVID-19. MAFLD is also associated with worse clinical outcomes of COVID-19, such as disease severity, ICU admission rate, and higher mortality rates. However, this evidence has not been well characterized in the literature. This meta-analysis aims to determine the clinical outcomes of COVID-19 among MAFLD patients compared to the non-MAFLD group.

 Methods. A comprehensive search was conducted in CINAHL, PubMed/Medline, and Embase for studies reporting MAFLD prevalence among COVID-19 patients and comparing clinical outcomes such as severity, ICU admission, and mortality among patients with and without MAFLD. We calculated the pooled prevalence of MAFLD among COVID-19 patients. Also, the pooled odds ratios (ORs) with 95% confidence interval (CI) were calculated for clinical outcomes of COVID-19.

Results. Twenty observational studies met inclusion criteria involving 13,036 overall study participants, including 2,374 MAFLD patients. The prevalence of COVID-19 among MAFLD patients was 0.28 (95% CI: 0.19-0.39). MAFLD was associated with the COVID-19 disease severity OR: 2.61 (95% CI: 1.77-3.83). Similarly, MAFLD was associated with an increased risk of ICU admission compared to the non-MAFLD group OR: 1.46 (95% CI: 1.12-1.91). Lastly, the association between MAFLD and COVID-19 mortality was not statistically significant OR: 1.25 (95% CI: 0.66-2.37).

Conclusions. There was a higher prevalence of MAFLD among COVID-19 patients than the non-MAFLD group. Moreover, MAFLD patients had an increased risk of COVID-19 disease severity and ICU admission rate.


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How to Cite

Hayat, U., Ashfaq, M. ., Johnson, L., Ford, R. ., Wuthnow, C., Kadado, K. ., El Jurdi, K., Okut, H., Kilgore, W., Assi, M., & Siddiqui, A. (2022). The Association of Metabolic-associated Fatty Liver Disease with Clinical Outcomes of COVID-19: A Systematic Review and Meta-Analysis: MAFLD and COVID-19 clinical outcomes. Kansas Journal of Medicine, 15(2), 241–246.



Original Research