Reply to "Does MAFLD really increase the severity of COVID-19?"

Dear Editor,

We would like to thank Fajar et al. [1] for the appreciation and interest in our study, as well as the insightful comments and concerns. The Authors stress that our paper provided important information in the context of COVID-19 management, particularly in patients with MAFLD. At the same time, they raised some questions, the following points should be noted:

First, there were not relatively enough studies investigating the association between MAFLD and severity of COVID-19, therefore we included these letters in our meta-analysis. The method used was supported by several published studies [2], [3], [4] .

Second, Zhou et al. and Targher et al. reported the number of COVID-19 co-exiting with MAFLD and the total COVID-19, which provided sufficient data to calculate the pooled prevalence of MAFLD among patients with COVID-19. The method of pooled analysis has been used in many high-quality publications in the literature [5], [6], [7], [8].

Third, the definition of COVID-19 severity in our meta-analysis was described in the section on method, according to the criteria listed in the Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (Trial Version 7). Targher et al. reported that MAFLD patients with neutrophil-tolymphocyte ratio (NLR) ≤ 2.8 were not associated with higher risk of severity of COVID-19 with adjusted odds ratio (5.32, 95%CI 0.98–29.90), in comparison to those without MAFLD and NLR ≤ 2.8. Since better data could not be obtained, thus we extracted the data in our pooled analysis for association between MAFLD and severity of COVID-19.

Declaration of Competing Interest

None declared.