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Risk of Serious Bacterial and Non-Bacterial Infections in People With MASLD
Giovanni Targher1,2, Herbert Tilg3, Luca Valenti4,5
1Department of Medicine, University of Verona, Verona, Italy.
Abstract:
Metabolic dysfunction-associated steatotic liver disease (MASLD) has become the most common chronic liver disease globally. MASLD is a multisystem disease where metabolic dysfunction plays a key role in the development of MASLD and its most relevant liver-related morbidities and extrahepatic complications, such as cardiovascular disease, chronic kidney disease and certain types of extrahepatic cancers. Among the least examined MASLD-related extrahepatic complications, an ever-increasing number of observational studies have reported a positive association between MASLD and the risk of serious bacterial infections (SBI) requiring hospital admission. This risk remained significant in those studies where statistical analysis was adjusted for age, sex, ethnicity, obesity, type 2 diabetes and other common comorbidities. Notably, the incidence rates of SBI were further increased with more advanced MASLD, especially in patients with MASLD-related cirrhosis, and were also observed for some acute viral infections, including SARS-CoV-2 infection, leading to severe COVID-19. In this narrative review article, we provide an overview of the literature on (a) the recent epidemiological data linking MASLD to the risk of serious bacterial and non-bacterial infections requiring hospital admission, (b) the putative underlying mechanisms through which MASLD may increase the susceptibility to serious infections, both directly and through the immune dysfunction associated with cirrhosis and portal hypertension, and (c) the practical and clinical implications of the increased risk of serious bacterial and non-bacterial infections in the growing global population with MASLD.
Insights
Metabolic dysfunction-associated steatotic liver disease (MASLD) increases the risk of serious bacterial and viral infections, particularly with advanced liver disease. Understanding these links is crucial for managing this growing global health issue.
Area of Science:
- Hepatology
- Infectious Diseases
- Metabolic Disorders
Background:
- Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease worldwide.
- MASLD is a multisystem condition linked to cardiovascular, kidney, and cancer complications.
- Emerging evidence links MASLD to an increased risk of serious infections requiring hospitalization.
Purpose of the Study:
- To review epidemiological data on MASLD and infection risk.
- To explore mechanisms underlying MASLD-associated increased susceptibility to infections.
- To discuss clinical implications for managing MASLD patients.
Main Methods:
- Narrative review of existing literature.
- Analysis of epidemiological studies on MASLD and infection incidence.
- Examination of proposed pathophysiological mechanisms.
Main Results:
- Observational studies consistently show a positive association between MASLD and serious bacterial infections (SBI).
- Infection risk escalates with MASLD severity, especially in cirrhosis.
- Increased susceptibility extends to viral infections like SARS-CoV-2.
Conclusions:
- MASLD significantly elevates the risk of serious bacterial and viral infections.
- Immune dysfunction, particularly in cirrhosis, contributes to infection susceptibility.
- Clinical awareness and management strategies are needed for MASLD patients at high infection risk.
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