Risk of Severe Infection in Patients With Biopsy-proven Nonalcoholic Fatty Liver Disease – A Population-based Cohort Study,Clinical Gastroenterology and Hepatology

当前位置： X-MOL 学术 › Clin. Gastroenterol. Hepatol. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Risk of Severe Infection in Patients With Biopsy-proven Nonalcoholic Fatty Liver Disease – A Population-based Cohort Study
Clinical Gastroenterology and Hepatology ( IF 11.6 ) Pub Date : 2023-05-26 , DOI: 10.1016/j.cgh.2023.05.013
Fahim Ebrahimi ₁ , Tracey G Simon ₂ , Hannes Hagström ₃ , Jonas Söderling ₄ , Axel Wester ₅ , Bjorn Roelstraete ₆ , Jonas F Ludvigsson ₇

Affiliation

Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Gastroenterology and Hepatology, University Center for Gastrointestinal and Liver Diseases, Basel, Switzerland.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Division of Gastroenterology and Hepatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Clinical and Translational Epidemiology Unit (CTEU), Massachusetts General Hospital, Boston, Massachusetts.
Division of Hepatology, Department of Upper GI, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York.

Background & Aims

It has been suggested that patients with nonalcoholic fatty liver disease (NAFLD) might be at increased risk of severe infections, but large-scale data from cohorts with biopsy-proven NAFLD are lacking.

Methods

Population-based cohort study including all Swedish adults with histologically confirmed NAFLD (n = 12,133) from 1969 to 2017. NAFLD was defined as simple steatosis (n = 8232), nonfibrotic steatohepatitis (n = 1378), noncirrhotic fibrosis (n = 1845), and cirrhosis (n = 678). Patients were matched to ≤5 population comparators (n = 57,516) by age, sex, calendar year, and county. Swedish national registers were used to ascertain incident severe infections requiring hospital admission. Multivariable adjusted Cox regression was used to estimate hazard ratios in NAFLD and histopathological subgroups.

Results

Over a median of 14.1 years, 4517 (37.2%) patients with NAFLD vs 15,075 (26.2%) comparators were hospitalized for severe infections. Patients with NAFLD had higher incidence of severe infections than comparators (32.3 vs. 17.0/1000 person-years; adjusted hazard ratio [aHR], 1.71; 95% confidence interval, 1.63−1.79). The most frequent infections were respiratory (13.8/1000 person-years) and urinary tract infections (11.4/1000 person-years). The absolute risk difference at 20 years after NAFLD diagnosis was 17.3%, equal to one extra severe infection in every 6 patients with NAFLD. Risk of infection increased with worsening histological severity of NAFLD (simple steatosis [aHR, 1.64], nonfibrotic steatohepatitis [aHR, 1.84], noncirrhotic fibrosis [aHR, 1.77], and cirrhosis [aHR, 2.32]. Also compared with their full siblings, patients with NAFLD were at increased risk of severe infections (aHR, 1.54; 95% confidence interval, 1.40–1.70).

Conclusions

Patients with biopsy-proven NAFLD were at significantly higher risk of incident severe infection requiring hospitalization both compared with the general population and compared with siblings. Excess risk was evident across all stages of NAFLD and increased with worsening disease severity.

中文翻译：

活检证实的非酒精性脂肪肝患者发生严重感染的风险——一项基于人群的队列研究

背景与目标

有人认为，非酒精性脂肪性肝病 (NAFLD) 患者发生严重感染的风险可能增加，但缺乏活检证实的 NAFLD 队列的大规模数据。

方法

基于人群的队列研究，包括 1969 年至 2017 年间所有经组织学证实患有 NAFLD 的瑞典成年人 (n = 12,133)。 NAFLD 被定义为单纯性脂肪变性 (n = 8232)、非纤维化脂肪性肝炎 (n = 1378)、非肝硬化纤维化 (n = 1845)和肝硬化 (n = 678)。按年龄、性别、历年和县将患者与 ≤5 个群体比较者 (n = 57,516) 进行匹配。瑞典国家登记册用于确定需要住院的严重感染事件。多变量调整 Cox 回归用于估计 NAFLD 和组织病理学亚组的风险比。

结果

在平均 14.1 年的时间里，有 4517 名 (37.2%) 名 NAFLD 患者因严重感染住院，而对照者为 15,075 名 (26.2%)。 NAFLD 患者的严重感染发生率高于对照组（32.3 vs. 17.0/1000 人年；调整后风险比 [aHR]，1.71；95% 置信区间，1.63−1.79）。最常见的感染是呼吸道感染（13.8/1000 人年）和尿路感染（11.4/1000 人年）。 NAFLD 诊断后 20 年的绝对风险差异为 17.3%，相当于每 6 名 NAFLD 患者就有 1 名额外严重感染者。感染风险随着 NAFLD 组织学严重程度的恶化而增加（单纯性脂肪变性 [aHR，1.64]、非纤维化脂肪性肝炎 [aHR，1.84]、非肝硬化纤维化 [aHR，1.77] 和肝硬化 [aHR，2.32]。同样与他们的同辈兄弟姐妹相比， NAFLD 患者严重感染的风险增加（aHR，1.54；95% 置信区间，1.40-1.70）。