World journal of hepatology · 2026
Dynamic immune response and its influencing factors in COVID-19 patients with non-alcoholic fatty liver disease: A cohort study.
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Yan Pan, Li Rui, Yuan Xiao-Yan, Wang Yong, Lan Li-Juan, Yu Xiao-Ping, Liu Da-Feng
Аннотация
BACKGROUND: Dynamic alterations in lymphocyte subsets demonstrate significant correlations with clinical disease severity in patients with coronavirus disease 2019 (COVID-19). As the most prevalent chronic liver disease globally, non-alcoholic fatty liver disease (NAFLD) exhibits distinct chronic inflammatory and immunometabolic disturbances that may substantially affect immune response patterns in COVID-19 patients. Nevertheless, the characteristics of lymphocyte subset dynamics and their clinical implications in COVID-19-NAFLD remain to be fully elucidated.
AIM: To characterize the dynamic changes in lymphocyte subsets among COVID-19 patients with NAFLD, in order to delineate their immunological profiles and inform clinical management strategies.
METHODS: The cohort study compared lymphocyte subpopulations in 858 COVID-19 patients and 670 COVID-19-NAFLD patients at admission, discharge, and 2-week/4-week post-discharge follow-ups.
RESULTS: Compared to COVID-19 patients without NAFLD, NAFLD-comorbid patients demonstrated persistently elevated CD3+CD4+ counts as well as lymphocyte counts and percentages at admission and at the 2-week and 4-week follow-ups post-discharge (all P < 0.05). Among COVID-19-NAFLD patients, those aged ≥ 60 years had significantly lower CD3+ counts, CD3+CD4+ counts, CD3+CD8+ counts, lymphocyte counts and percentages, and CD19+ counts and percentages at all assessed time points (all P < 0.05); significant liver fibrosis correlated with reduced CD3+CD4+ counts, CD3+CD8+ counts, and lymphocyte counts and percentages across all time points (all P < 0.05); multimorbidity (≥ 3 comorbidities) exacerbated immune imbalance, marked by elevated CD3+CD4+ percentages and CD56+ counts at admission, increased CD3+CD4+ counts, lymphocyte counts, and CD19+ counts and percentages at discharge, as well as sustained increases in CD3+CD4+ counts at the 2-week follow-up and higher CD3+CD4+ percentages at the 4-week post-discharge follow-up (all P < 0.05); and obesity and elevated liver enzymes were independently linked to higher CD3+CD4+ counts, CD19+ counts, and lymphocyte counts at all post-admission evaluations (from discharge through the 4-week follow-up) (all P < 0.05).
CONCLUSION: Age, liver fibrosis, comorbidities, obesity, liver enzyme abnormalities, vaccination status, low-density lipoprotein cholesterol, and hemoglobin A1c significantly modulate immune responses in COVID-19-NAFLD patients, warranting targeted clinical attention. Furthermore, patients with uncomplicated NAFLD (including lean NAFLD) also require particular clinical attention to mitigate risks of immune imbalance.
AIM: To characterize the dynamic changes in lymphocyte subsets among COVID-19 patients with NAFLD, in order to delineate their immunological profiles and inform clinical management strategies.
METHODS: The cohort study compared lymphocyte subpopulations in 858 COVID-19 patients and 670 COVID-19-NAFLD patients at admission, discharge, and 2-week/4-week post-discharge follow-ups.
RESULTS: Compared to COVID-19 patients without NAFLD, NAFLD-comorbid patients demonstrated persistently elevated CD3+CD4+ counts as well as lymphocyte counts and percentages at admission and at the 2-week and 4-week follow-ups post-discharge (all P < 0.05). Among COVID-19-NAFLD patients, those aged ≥ 60 years had significantly lower CD3+ counts, CD3+CD4+ counts, CD3+CD8+ counts, lymphocyte counts and percentages, and CD19+ counts and percentages at all assessed time points (all P < 0.05); significant liver fibrosis correlated with reduced CD3+CD4+ counts, CD3+CD8+ counts, and lymphocyte counts and percentages across all time points (all P < 0.05); multimorbidity (≥ 3 comorbidities) exacerbated immune imbalance, marked by elevated CD3+CD4+ percentages and CD56+ counts at admission, increased CD3+CD4+ counts, lymphocyte counts, and CD19+ counts and percentages at discharge, as well as sustained increases in CD3+CD4+ counts at the 2-week follow-up and higher CD3+CD4+ percentages at the 4-week post-discharge follow-up (all P < 0.05); and obesity and elevated liver enzymes were independently linked to higher CD3+CD4+ counts, CD19+ counts, and lymphocyte counts at all post-admission evaluations (from discharge through the 4-week follow-up) (all P < 0.05).
CONCLUSION: Age, liver fibrosis, comorbidities, obesity, liver enzyme abnormalities, vaccination status, low-density lipoprotein cholesterol, and hemoglobin A1c significantly modulate immune responses in COVID-19-NAFLD patients, warranting targeted clinical attention. Furthermore, patients with uncomplicated NAFLD (including lean NAFLD) also require particular clinical attention to mitigate risks of immune imbalance.