Correlations of clinical and diagnostic indicators in patients with metabolic-associated steatotic liver disease with the immune response to SARS-CoV-2

Background. Metabolic-associated steatotic liver di­sease (MASLD) is one of the most common chronic liver disorders linked to systemic metabolic and inflammatory dysfunctions. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can aggravate the course of MASLD through immune and inflammatory mechanisms, emphasizing the need for a personalized diagnostic approach. The purpose was to determine the correlations between clinical and biochemical parameters, immune response, hemostatic profile, and metabolic alterations in patients with MASLD and immune response to SARS-CoV-2, in order to develop personalized diagnostic criteria. Materials and methods. A total of 105 patients with MASLD and 20 healthy controls were examined. Patients were stratified based on the presence of IgG antibodies to SARS-CoV-2. The comprehensive study included evaluation of lipid and carbohydrate metabolism, inflammatory markers (interleukin (IL) 6, IL-10, tumor necrosis factor α), hemostatic parameters, and insulin resistance index. Statistical analysis was performed using nonparametric Mann-Whitney and Kruskal-Wallis tests, and Spearman’s correlation (p < 0.05). Results. In patients with MASLD and immune response to SARS-CoV-2, moderate correlations were found between triglycerides (TG) and hepatic steatosis (r = 0.317; p < 0.01), very-low-density lipoprotein levels (r = 0.227; p < 0.05), and the atherogenic coefficient (r = 0.242; p < 0.05). The insulin resistance index (HOMA-IR) correlated posi­tively with TG (r = 0.625; p < 0.01), while IL-6 correlated with the atherogenic coefficient (r = 0.25; p < 0.05). A negative correlation was found between mean platelet volume and nitric oxide metabolites (r = –0.332; p < 0.01). Elevated mean corpuscular hemoglobin (> 31) was observed in 55.2 % of patients and was associated with decreased NOx levels (p = 0.002) and reduced heptadecanoic acid concentrations (p = 0.005). A decrease in thrombin time (< 18.4 s) was detected in 40 % of patients and was accompanied by statistically significant changes in monounsaturated fatty acid levels (p = 0.021). Overall, post-COVID-19 patients demonstrated a 2.4-fold increase in TG, a 1.9-fold elevation in very-low-density lipoproteins, and a 1.5-fold reduction in high-density lipoproteins compared to controls (p < 0.01). Conclusions. The study confirms strong interrelations between metabolic, inflammatory, and hemostatic shifts in MASLD patients following SARS-CoV-2 infection. A personalized approach allows increasing the accuracy of assessing clinical and diagnostic indicators and predicting complications.