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Published on: July 19, 2024
Metabolic Dysfunction-Associated Steatotic Liver Disease Increases the Risk of Severe Infection: A Population-Based
Background And Aims:
Metabolic dysfunction-associated steatotic liver disease (MASLD) is linked to various intrahepatic and extrahepatic diseases, but its association with severe infectious disease remains to be investigated.
Methods:
We analysed data from the Shanghai Suburban Adult Cohort and Biobank, encompassing participants enrolled in 2016 and 2017 with available abdominal ultrasonography data, and followed them up until December 2022 (median follow-up = 5.71 years). We categorised the participants into the MASLD group and those without steatotic liver disease (non-SLD). Multivariable-adjusted Cox regression was used to estimate hazard ratios (HR) for severe infections in patients with MASLD compared to the non-SLD group. Cumulative incidences were calculated while accounting for competing risks (non-infection-related deaths). Mediation analyses were performed to explore the roles of cardiometabolic risk factors in the association between MASLD and severe infections.
Results:
Among the 33 072 eligible participants (mean age 56.37 years; 38.20% male), 11 908 (36.01%) were diagnosed with MASLD at baseline. Severe infections occurred in 912 (7.66%) MASLD patients and 1258 (5.94%) non-SLD. The rate of severe infections per 1000 person-years was higher in MASLD patients (13.58) than in comparators (10.48) (fully adjusted HR 1.18, 95% CI 1.07-1.30). The most frequent infections in MASLD were respiratory (7.25/1000 person-years) and urinary tract infections (2.61/1000 person-years). The 5-year cumulative incidence of severe infections was 6.79% (95% CI 6.36-7.26) in MASLD and 5.08% (95% CI 4.79-5.38) in comparators. Cardiometabolic risk factors, including waist circumference, triglycerides and HbA1C, partially mediate the association between MASLD and severe infections.
Conclusions:
Patients with MASLD were at significantly higher risk of incident severe infections compared to the non-SLD group. Future studies are needed to elucidate the mechanisms linking MASLD to severe infections.
Insights
Metabolic dysfunction-associated steatotic liver disease (MASLD) patients face a higher risk of severe infections. Cardiometabolic factors partially explain this increased susceptibility, highlighting a crucial link between liver health and infection risk.
Area of Science:
- Hepatology
- Infectious Diseases
- Metabolic Health
Background:
- Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with numerous health issues.
- The link between MASLD and severe infections is not well understood.
Purpose of the Study:
- To investigate the association between MASLD and the risk of developing severe infections.
- To explore the role of cardiometabolic risk factors in this association.
Main Methods:
- Analysis of data from the Shanghai Suburban Adult Cohort and Biobank (33,072 participants).
- Participants were categorized into MASLD and non-SLD groups.
- Multivariable-adjusted Cox regression and mediation analyses were employed.
Main Results:
- MASLD patients (11,908) showed a significantly higher risk of severe infections (HR 1.18; 95% CI 1.07-1.30).
- The 5-year cumulative incidence of severe infections was higher in the MASLD group (6.79%) compared to non-SLD (5.08%).
- Cardiometabolic factors like waist circumference, triglycerides, and HbA1C partially mediated the MASLD-infection link.
Conclusions:
- MASLD is an independent risk factor for incident severe infections.
- Further research is needed to clarify the underlying mechanisms connecting MASLD and severe infections.
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