The Incidence of COVID-19 in Patients With Metabolic Syndrome and Non-Alcoholic Steatohepatitis: A Population-Based Study

INTRODUCTION: The novel coronavirus disease (COVID-19) emerged from China in 2019 and rapidly spread worldwide Patients with metabolic comorbid conditions are more susceptible to COVID- 19 Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome, with non-alcoholic steatohepatitis (NASH) representing a severe form of NAFLD The aim of this study is to determine the relationship between metabolic syndrome components and the risk of COVID-19 METHODS: We reviewed data from a large commercial database (Explorys IBM) that aggregates electronic health records from 26 large nationwide healthcare systems We identified adult with the diagnosis of metabolic syndrome and its components from 1999 to 2019 Patients with the diagnosis of COVID-19 from December 2019 to May 2020 were identified Comorbidities known to be associated with COVID-19 and metabolic syndrome such as obesity, diabetes mellitus, dyslipidemia, smoking, gender, race, and hypertension were collected Univariable and multivariable analyses were performed to investigate whether metabolic syndrome or its individual components are independently associated with the risk of COVID-19 RESULTS: Out of 61 4 million patients, 8,885 (0 01%) had documented COVID-19 infection Using univariate analysis, patients with metabolic syndrome had a higher cumulative incidence of COVID-19 than those without (0 10% vs 0 01%, OR 7 00 [6 11-8 01) Patients had increased risk if they were diagnosed with hypertension (0 04% vs 0 01%, OR 5 81 [5 57-6 07]), diabetes (0 05% vs 0 01%, OR 4 88 [4 67-5 10]), dyslipidemia (0 04% vs 0 01%, OR 4 22 [4 05-4 40]) or obesity (0 06% vs 0 01%, OR 6 13 [5 86-6 40]) African Americans had a higher risk of COVID-19 (0 07% vs 0 01%, OR 9 20 [8 82-9 59]), but the risk was lower if they were male (0 02% vs 0 01%, OR 0 85 [0 81-0 89]) The overall risk of COVID-19 was the highest in those diagnosed with NASH (0 20% vs 0 01%, OR 14 10 [11 63-17 10]) The adjusted odds (aOR) of having COVID-19 was higher if patients were African American (OR 7 45 [7 14-7 77]), hypertensive (aOR 2 53 [2 40-2 68]), obese (aOR 2 20 [2 10 2 32]), diabetic (aOR 1 41 [1 33-1 48]) had dyslipidemia (OR 1 70 [1 56-1 74]) or NASH (OR 4 93 [4 05-6 00]) The adjusted odds of having COVID-19 was also lower in males compared to females (aOR 0 88 [0 84-0 92]) CONCLUSION: The incidence of COVID-19 in patients with metabolic syndrome is high Among all comorbid metabolic conditions, NASH has the strongest association with COVID-19