Mantovani Alessandro, Morandin Riccardo, Fiorio Veronica, Lando Maria Giovanna, Gaviraghi Alberto, Motta Leonardo, Gobbi Federico, Tilg Herbert, Byrne Christopher D, Targher Giovanni
Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy.
Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella, Italy.
Liver Int. 2025 Apr;45(4):e16101. doi: 10.1111/liv.16101. Epub 2024 Sep 11.
Previous studies have reported an association between metabolic dysfunction-associated steatotic liver disease (MASLD) and the risk of serious bacterial infections. However, the magnitude of the risk and whether this risk varies with the severity of MASLD remains uncertain. We performed a meta-analysis of observational studies to quantify the association between MASLD and serious bacterial infections requiring hospital admission.
We systematically searched PubMed, Scopus, Web of Science and Embase from database inception to 1 April 2024, using predefined keywords to identify studies examining the risk of serious bacterial infections among individuals with and without MASLD. MASLD was diagnosed using liver biopsy, imaging or International Classification of Diseases codes. Meta-analysis was performed using random-effects modelling.
We identified six cross-sectional and two prospective cohort studies with aggregate data on ~26.6 million individuals. MASLD was significantly associated with higher odds of serious bacterial infections (pooled random-effects odds ratio 1.93, 95% confidence interval [CI] 1.44-2.58; I = 93%). Meta-analysis of prospective cohort studies showed that MAFLD was associated with an increased risk of developing serious bacterial infections (pooled random-effects hazard ratio 1.80, 95% CI 1.62-2.0; I = 89%). This risk further increased across the severity of MASLD, especially the severity of fibrosis (pooled random-effects hazard ratio 2.42, 95% CI 1.89-2.29; I = 92%). These results remained significant after adjusting for age, sex, obesity, diabetes and other potential confounders. Sensitivity analyses did not modify these findings. The funnel plot did not reveal any significant publication bias.
This meta-analysis shows a significant association between MASLD and an increased risk of serious bacterial infections requiring hospital admission.
既往研究报告了代谢功能障碍相关脂肪性肝病（MASLD）与严重细菌感染风险之间的关联。然而，该风险的程度以及此风险是否随MASLD的严重程度而变化仍不确定。我们进行了一项观察性研究的荟萃分析，以量化MASLD与需要住院治疗的严重细菌感染之间的关联。
我们从数据库建立至2024年4月1日，系统检索了PubMed、Scopus、Web of Science和Embase，使用预定义关键词来识别研究有或无MASLD个体中严重细菌感染风险的研究。MASLD通过肝活检、影像学或国际疾病分类代码进行诊断。采用随机效应模型进行荟萃分析。
我们确定了六项横断面研究和两项前瞻性队列研究，汇总数据涉及约2660万人。MASLD与严重细菌感染的较高几率显著相关（合并随机效应比值比1.93，95%置信区间[CI]1.44 - 2.58；I² = 93%）。前瞻性队列研究的荟萃分析表明代谢相关脂肪性肝病（MAFLD）与发生严重细菌感染的风险增加相关（合并随机效应风险比1.80，95% CI 1.62 - 2.0；I² = 89%）。该风险随着MASLD严重程度的增加而进一步升高，尤其是纤维化的严重程度（合并随机效应风险比2.42，95% CI 1.89 - 2.29；I² = 92%）。在调整年龄、性别、肥胖、糖尿病和其他潜在混杂因素后，这些结果仍然显著。敏感性分析未改变这些发现。漏斗图未显示任何显著的发表偏倚。
这项荟萃分析表明MASLD与需要住院治疗的严重细菌感染风险增加之间存在显著关联。
