Clinical manifestations and indicators of the hemostasis system in patients with nonalcoholic fatty liver disease with an immune response to SARS-CoV-2
Authors: Didenko V.I. , Yagmur V.B. , Klenina I.A. , Tatarchuk O.M. , Ruban K.A. , Petishko O.P. 
Published: October 2023

Background. Nonalcoholic fatty liver disease (NAFLD) is often accompanied by comorbid conditions such as obesity, type 2 diabetes, and cardiovascular diseases, which are risk factors for severe coronavirus disease (COVID-19). The latter is characterized by respiratory failure and hyperinflammation with the risk of further multiorgan failure, and disorders in the hemostasis system. Purpose: to determine the clinical manifestations and features of hemostasis in NAFLD in patients with an immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Materials and methods. Thirty-seven patients with NAFLD were under observation, and immunoglobulins G to SARS-CoV-2 were detected in them. Group I consisted of 19 patients who did not suffer from COVID-19. Group II included 18 patients with COVID-19 confirmed by a polymerase chain reaction. Patients of groups I and II were vaccinated against coronavirus. Clinical symptoms, the state of hemostasis in the vascular-platelet link, the state of coagulation, the content of fibrinogen and plasminogen activator inhibitor-1 (PAI-1) were assessed in all patients. Results. Patients with NAFLD and an immune response to SARS-CoV-2 reported a pain syndrome in 70.3 % of cases: group I more often complained of pain in the right (68.4 %) and left (52.6 %) hypochondria, group II — of epigastric pain (66.7 %). Among manifestations of dyspeptic syndrome observed in 28 (75.7 %) patients, in group I complaints of abdominal distension (31.6 %) and stomach rumble (21.1 %) prevailed, in group II — of abdominal distension (50.0 %) and bitter taste in mouth (27.8 %). Concomitant cardiovascular pathology was detected in 32.4 % of cases. The synthetic function of the liver in terms of coagulation factors was almost preserved, but a probable increase in the content of coagulation factor II was observed in patients of group I (p < 0.05). PAI-1 level correlated with prothrombin content (r = 0.365; p = 0.024) and platelet count (r = 0.368; p = 0.023). Conclusions. Patients with an immune response to SARS-CoV-2 in NAFLD had the peculiarities of the clinical picture. In particular, those who did not suffer from COVID-19 complained of pain in the right hypochondrium 1.5 times more often and noted stomach rumble 2 times more often; also, in the hemostasis system, a tendency to increase the number of platelets was revealed compared to the controls (p > 0.05). Meanwhile, among patients with COVID-19, abdominal bloating (by 1.6 times) and bitter taste in mouth (by 2 times) prevailed, and in the hemostasis system, a decrease in the number of platelets was noted compared to the controls (p > 0.05). Patients of both groups had an increase in the average number of platelets by 10 % (p > 0.05). A significant increase by 20 % (p < 0.05) was noted in the content of coagulation factor II and by 12 % in the level of PAI-1 in group I. Correlations of PAI-1 with indicators of the platelet link indicate its participation in the functioning of the homeostasis system.