Association Between Metabolic Dysfunction-Associated Steatotic Liver Disease and Increased Risk of Severe Bacterial Infections: A Meta-Analysis

Abstract

Background Previous studies have reported an association between metabolic dysfunction-associated steatotic liver disease (MASLD) and risk of severe 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 severe bacterial infections requiring hospital admission. Methods We systematically searched PubMed, Scopus, Web of Science and Embase from database inception to April 1, 2024, using predefined keywords to identify studies examining the risk of severe bacterial infections amongst individuals with and without MASLD. MASLD was diagnosed using biopsy, imaging, or International Classification of Diseases codes. Meta-analysis was performed using random-effects modelling. Results We identified six cross-sectional and two prospective studies with aggregate data on ~ 26.6 million individuals. MASLD was significantly associated with higher odds of severe bacterial infections (pooled random-effects odds ratio 1.93, 95%CI 1.44–2.58; I² = 93%). Meta-analysis of data from prospective studies showed that MAFLD was associated with an increased risk of developing incident severe infections (pooled random-effects hazard ratio 1.80, 95%CI 1.62-2.0; I² = 89%). This risk significantly increased across the severity of MASLD, especially the severity of fibrosis (pooled random-effects hazard ratio 2.42, 95%CI 1.89–2.29; I² = 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. Conclusions This meta-analysis shows a significant association between MASLD and increased risk of severe bacterial infections requiring hospital admission.