Infection Risk in Patients with Biopsy-Proven Fatty Liver Disease: A Cohort Study

Abstract

Introduction: Nonalcoholic fatty liver disease (NAFLD). is increasingly becoming one of the most common complex disorders worldwide and is related to higher morbidity because of its potential to progress to cirrhosis and hepatocellular carcinoma. Few recent studies have also suggested that NAFLD might predispose to severe infections, although the data are extremely limited, hence increasing the knowledge gap that necessitates delving into the depths of understanding potential risks of infection at the different stages of NAFLD. Objective: To determine the incidence and hazard of severe infections at different stages of biopsy-proven NAFLD compared with an age- and sex-matched general population.

Methods: This was a population-based cohort study conducted from the year 1995 to 2017 with a follow-up from the diagnosis date of 133 biopsy-proven cases of NAFLD and 629 general population comparators. All cases of NAFLD were matched for age, gender, and socioeconomic status. We stratified cases according to NAFLD severity: simple steatosis; NASH without fibrosis; noncirrhotic fibrosis; and cirrhosis. A data source for the study is an electronic health record that collects the baseline characteristics, clinical history, and time to infection events. Rates of incidence of infections are denoted as the number of events per 1,000 person years and analyzed through Cox proportional hazards models after adjusting the potential confounders. The SPSS version used was 25.

Results: The overall incidence of infection was significantly higher in the NAFLD group than in the general population (17.9 vs. 11.3 per 1000 person-years). Particularly, the rates of sepsis (8.3 vs. 4.2 per 1000 person-years)., infections of the respiratory tract (17.7 vs. 13.3 per 1000 person-years). and urinary tract infections (14.8 vs. 11.0 per 1000 person-years). were significantly higher in the NAFLD group. Hazard ratios for these infections ranged from 1.52 to 3.16, indicating a significantly increasing risk associated with the progression of the severity of disease.

Conclusion: Patients with NAFLD proven on biopsy were at markedly high risk of severe infections, which increased with the severity of the disease. The study highlights the need for stepped-up surveillance and prevention against infections in NAFLD patients to avert health deterioration and improve their outcomes.

Keywords: Nonalcoholic Fatty Liver Disease, Infection, Epidemiology, Liver Disease, Health Risk, Cohort Study, SPSS