COPD and MAFLD: Prevalence, Clinical Characteristics, and Impact on Frequent Exacerbations

Abstract Background: Metabolic-associated fatty liver disease (MAFLD) affects approximately 24% of the global population and can lead to cirrhosis and hepatocellular carcinoma. This study aimed to assess the prevalence, clinical characteristics of MAFLD, and its impact on patients with Chronic Obstructive Pulmonary Disease (COPD). Methods: This cross-sectional descriptive study included stable COPD patients at Gia Định People's Hospital from June 2023 to June 2024. FibroScan was used to detect fatty liver, applying the 2020 APASL criteria for diagnosing MAFLD. Results: Among 168 COPD patients, 48.8% were diagnosed with MAFLD. The mean age was 68.3 ± 8.9 years, and the average BMI was 21.2 ± 3.5 kg/m². Patients with MAFLD showed significantly worse lung function, with lower FEV1 (57.2% vs. 67.0%, p=0.002) and FVC (80.8% vs. 88.1%, p=0.009) than those without MAFLD. Dyspnea was more severe in the MAFLD group, with 91.5% having a modified Medical Research Council (mMRC) score ≥2 compared to 76.7% in the non-MAFLD group (p=0.009). Additionally, 46.3% of MAFLD patients experienced ≥2 exacerbations in the past year, compared to 30.2% in non-MAFLD patients (p=0.032). Elevated Controlled Attenuation Parameter (CAP) scores (>289 dB/m) were significantly associated with frequent exacerbations (OR 5.64, p=0.001). MAFLD was identified as an independent risk factor for exacerbations (OR 3.64, p=0.014). Conclusion: Nearly half of the COPD patients in this study had MAFLD. These patients had worse lung function and more frequent exacerbations. Elevated CAP scores were strongly associated with exacerbations, highlighting MAFLD as an independent risk factor for increased exacerbation risk in COPD patients. Keywords: Metabolic-associated fatty liver disease, MAFLD, Chronic obstructive pulmonary disease, COPD, FibroScan, Fatty liver.