Risk of infections in non‐alcoholic fatty liver disease: A nationwide population‐based cohort study

Abstract

AbstractBackground and AimsPrevious 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.MethodsIn 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).ResultsSevere 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.ConclusionNAFLD 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.