Inactivated vaccines reduce the risk of liver function abnormality in NAFLD patients with COVID-19: a multi-center retrospective studyResearch in context
Zhixue Chen,
Wenqing Tang,
Nana Feng,
Minzhi Lv,
Fansheng Meng,
Huibin Wu,
Yitong Zhao,
Huajie Xu,
Yuxin Dai,
Jindan Xue,
Jingya Wang,
Anjun Xu,
Beilin Zhang,
Dejie Chu,
Yuqin Li,
Dejun Wu,
Ling Dong,
Si Zhang,
Ruyi Xue
Affiliations
Zhixue Chen
Department of Gastroenterology and Hepatology, Shanghai Institute of Liver Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
Wenqing Tang
Department of Gastroenterology and Hepatology, Shanghai Institute of Liver Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
Nana Feng
Department of Respiratory and Critical Medicine, Shanghai Eighth People’s Hospital Affiliated to Jiang Su University, Shanghai, 200030, China
Minzhi Lv
Clinical Research Unit, Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, 200032, China; Department of Biostatistics, Clinical Research Unit, Key Laboratory of Public Health Safety of Ministry of Education, Key Laboratory for Health Technology Assessment, National Commission of Health, School of Public Health, Center of Evidence-Based Medicine, Fudan University, Shanghai, 200032, China
Fansheng Meng
Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
Huibin Wu
Department of Gastroenterology and Hepatology, Shanghai Institute of Liver Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
Yitong Zhao
School of Medicine, Anhui University of Science and Technology, Anhui, 232000, China
Huajie Xu
Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, 200032, China
Yuxin Dai
NHC Key Laboratory of Glycoconjugate Research, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, China
Jindan Xue
School of Medicine, Anhui University of Science and Technology, Anhui, 232000, China
Jingya Wang
Department of Biochemistry and Molecular Biology, Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, China
Anjun Xu
Department of General Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
Beilin Zhang
Department of Gastroenterology and Hepatology, Shanghai Baoshan District Wusong Central Hospital (Zhongshan Hospital Wusong Branch, Fudan University), Shanghai, 200940, China
Dejie Chu
Department of Respiratory and Critical Medicine, Shanghai Eighth People’s Hospital Affiliated to Jiang Su University, Shanghai, 200030, China
Yuqin Li
Department of Gastroenterology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
Dejun Wu
Department of General Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China; Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China; Corresponding author. Department of General Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China.
Ling Dong
Department of Gastroenterology and Hepatology, Shanghai Institute of Liver Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, China; Corresponding author. Department of Gastroenterology and Hepatology, Shanghai Institute of Liver Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
Si Zhang
NHC Key Laboratory of Glycoconjugate Research, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, China; Corresponding author. NHC Key Laboratory of Glycoconjugate Research, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, China.
Ruyi Xue
Department of Gastroenterology and Hepatology, Shanghai Institute of Liver Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, China; Department of Gastroenterology and Hepatology, Shanghai Baoshan District Wusong Central Hospital (Zhongshan Hospital Wusong Branch, Fudan University), Shanghai, 200940, China; Corresponding author. Department of Gastroenterology and Hepatology, Shanghai Institute of Liver Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
Summary: Background: Abnormal liver function was frequently observed in nonalcoholic fatty liver disease (NAFLD) patients infected with SARS-CoV-2. Our aim was to explore the effect of SARS-CoV-2 inactivated vaccines on liver function abnormality among NAFLD patients with COVID-19. Methods: The multi-center retrospective cohort included 517 NAFLD patients with COVID-19 from 1 April to 30 June 2022. Participants who received 2 doses of the vaccine (n = 274) were propensity score matched (PSM) with 243 unvaccinated controls. The primary outcome was liver function abnormality and the secondary outcome was viral shedding duration. Logistic and Cox regression models were used to calculate the odds ratio (OR) and hazard ratio (HR) for the outcomes. Sensitivity analysis was conducted to assess robustness. Findings: PSM identified 171 pairs of vaccinated and unvaccinated patients. Liver function abnormality was less frequent in the vaccinated group (adjusted OR, 0.556 [95% CI (confidence interval), 0.356–0.869], p = 0.010). Additionally, the vaccinated group demonstrated a lower incidence of abnormal bilirubin levels (total bilirubin: adjusted OR, 0.223 [95% CI, 0.072–0.690], p = 0.009; direct bilirubin: adjusted OR, 0.175 [95% CI, 0.080–0.384], p < 0.001) and shorter viral shedding duration (adjusted HR, 0.798 [95% CI, 0.641–0.994], p = 0.044) than the unvaccinated group. Further subgroup analysis revealed similar results, while the sensitivity analyses indicated consistent findings. Interpretation: SARS-CoV-2 vaccination in patients with NAFLD may reduce the risk of liver dysfunction during COVID-19. Furthermore, vaccination demonstrated beneficial effects on viral shedding in the NAFLD population. Funding: 23XD1422700, Tszb2023-01, Zdzk2020-10, Zdxk2020-01, 2308085J27 and JLY20180124.
