Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Liver Int. 2023 Oct;43(10):2142-2152. doi: 10.1111/liv.15680. Epub 2023 Jul 20.
Previous literature suggests an association between non-alcoholic fatty liver disease (NAFLD) and infections. We aimed to determine the rate and risk of severe infections in NAFLD compared to the general population.
In this population-based cohort study, we used national registers to identify all patients with a hospital-based diagnosis of NAFLD in Sweden 1987-2020 (n = 14 869). The patients were matched with ≤10 comparators from the general population for age, sex, municipality, and calendar year (n = 137 145). Cox regression was used to estimate hazard ratios (HR) for infections in patients with NAFLD compared to comparators. Cumulative incidences were calculated while accounting for competing risks (non-infection death and liver transplantation).
Severe infections leading to death or hospitalization occurred in 1990 (13.4%) patients with NAFLD and 9899 (7.2%) comparators during a median of 4.5 and 6.1 years of follow-up, respectively. The rate of severe infections per 1000 person-years was higher in patients with NAFLD (21.0) than comparators (9.1) independently of components related to the metabolic syndrome (adjusted HR 1.9, 95% CI = 1.8-2.0). Infection-related mortality was also higher in NAFLD compared to comparators (adjusted HR 1.8, 95% CI = 1.6-2.2). The 10-year cumulative incidence of severe infections was 16.6% (95% CI = 15.8-17.4) in NAFLD and 8.0% (95% CI = 7.8-8.2) in comparators.
NAFLD was associated with severe infections and infection-related mortality, independently of components associated with the metabolic syndrome. Increased clinical vigilance of severe infections in NAFLD may diminish the risk of premature death.
既往文献提示非酒精性脂肪性肝病（NAFLD）与感染之间存在关联。本研究旨在确定与普通人群相比，NAFLD 患者严重感染的发生率和风险。
在这项基于人群的队列研究中，我们使用国家登记处确定了瑞典 1987-2020 年期间所有以医院为基础诊断为 NAFLD 的患者（n=14869）。将这些患者与年龄、性别、市和年份相匹配的普通人群中的 ≤10 名对照者（n=137145）进行匹配。使用 Cox 回归估计与对照者相比，NAFLD 患者感染的风险比（HR）。在考虑竞争风险（非感染性死亡和肝移植）的情况下计算累积发生率。
在中位随访 4.5 和 6.1 年期间，分别有 1990 例（13.4%）NAFLD 患者和 9899 例（7.2%）对照者发生严重感染导致死亡或住院治疗。NAFLD 患者每 1000 人年严重感染率（21.0）高于对照者（9.1），且独立于与代谢综合征相关的成分（调整 HR 1.9，95%CI=1.8-2.0）。NAFLD 患者的感染相关死亡率也高于对照者（调整 HR 1.8，95%CI=1.6-2.2）。NAFLD 患者 10 年严重感染累积发生率为 16.6%（95%CI=15.8-17.4），而对照者为 8.0%（95%CI=7.8-8.2）。
NAFLD 与严重感染和感染相关死亡率相关，与代谢综合征相关成分无关。增加对 NAFLD 患者严重感染的临床监测可能会降低过早死亡的风险。
