A retrospective study of COVID‑19 in patients with metabolic dysfunction‑associated fatty liver disease (MAFLD) in Saudi Arabia

Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) has emerged as a significant comorbidity in COVID-19 patients. This retrospective case-control study included 224 COVID-19 patients (112 with MAFLD and 112 without MAFLD) for clinical and biochemical evaluation. Data collection followed a consecutive sampling protocol was performed using a random number generator on the list of eligible patients, incorporating all patients who met the inclusion criteria during the study period to ensure a representative and unbiased clinical sample. MAFLD patients demonstrated considerably worse clinical profiles compared to controls, with higher obesity rates (78% vs. 22%), prolonged hospitalization (84% vs. 16%), and more severe COVID-19 presentations (45% vs. 55%). During infection, significant differences were observed in AST, CRP, HSI, and AST/ALT ratio (p<0.05), while post-infection findings revealed significant changes in AST, PLT, PTT, and HIS (p<0.05), reflecting notable hepatic and hematological disruption. Multivariate logistic regression identified several independent risk factors influencing clinical outcomes. Saudi nationality was a significant predictor (adjOR = 0.289; p = 0.027), while hospital admission carried the highest associated risk (adjOR = 8.315; p < 0.001). COVID-19 severity also remained an independent contributing factor (adjOR = 0.291; p = 0.010). Among post-infection laboratory markers, both platelet count (adjOR = 1.003; p = 0.028) and the AST/ALT ratio (adjOR = 2.674; p = 0.018) were confirmed as independent variables influencing overall outcome. The clinical burden within the MAFLD cohort was substantial, with a mortality rate of 31.3% (35/112) and a recovery rate of only 68.8% (77/112), both significantly lower than in the control group. Notably, MAFLD alone was not found to be directly life-threatening; rather, COVID-19 severity remained the primary driver of adverse outcomes. In conclusion, the study confirms MAFLD as an important prognostic factor in COVID-19 patients, highlighting the need of clinical management for this high-risk population during pandemics.