Association of metabolic dysfunction-associated fatty liver disease with gastrointestinal infections: insights from National Inpatient Sample Database

Abstract

ObjectivesThe study aimed to compare the risk of gastrointestinal infections among patients with and without metabolic dysfunction-associated fatty liver disease (MAFLD).MethodsThis was a population-based, retrospective, observational study using data from the National Inpatient Sample (NIS), the largest all-payer US inpatient care database.SettingHospitalisation of adults aged ≥18 years old admitted in 2020 was identified using the NIS. Patients were stratified by the presence and absence of MAFLD.Participants26.4 million adults aged ≥18 years old were included in the study. Patients younger than 18 and those with missing demographic or mortality data were excluded.Primary and secondary outcomesPrimary outcome was to assess the overall risk of gastrointestinal infections in patients with and without MAFLD. Secondary outcomes were demographics and comorbidities stratified by the presence or absence of gastrointestinal infection, and the risk of specific gastrointestinal pathogens.ResultsOf 26.4 million patients admitted in 2020, 755 910 (2.85%) had the presence of MAFLD. There was a higher prevalence of bacterial gastrointestinal infections in patients with MAFLD than those without (1.6% vs 0.9%, p<0.001). The incidence ofClostridioides difficile(1.3% vs 0.8%, p<0.001),Escherichia coli(0.3% vs 0.01%, p<0.001), andSalmonella(0.07% vs 0.03%, p<0.001) was higher in patients with MAFLD. The presence of MAFLD was associated with higher odds of developing gastrointestinal infections (adjusted OR (aOR) −1.75, 95% CI −1.68 to 1.83, p<0.001). After adjusting for confounders, results remained statistically significant (aOR −1.36, 95% CI - 1.30-1.42, p<0.001).ConclusionEven after adjusting for confounding factors, our study demonstrates an increased risk of gastrointestinal infections in patients with MAFLD, specifically ofC. difficile,E. coli, andSalmonella. The immune and microbiota changes seen within MAFLD potentially contribute to the increased risk of gastrointestinal infections.

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

“…The main characteristics of these selected observational studies are shown in Table 1 (15)(16)(17)(18)(19)(20)(21)(22). Overall, the 6 cross-sectional hospital-based studies included 26,434,377 individuals hospitalized for severe bacterial infections (43.6% men; mean age 60 years; ~36% had a diagnosis of MASLD).…”

“…Cross-sectional studies on the association between MASLD and severe bacterial infections distribution of cross-sectional studies (involving 26,434,377 adult individuals from different countries) by estimate of the association between MASLD and the risk of severe bacterial infections is plotted in Fig. 1 (15)(16)(17)(18)(19)(20). We found that MASLD was signi cantly associated with higher odds of severe bacterial infections (n = 6 studies; pooled random-effects odds ratio 1.93, 95%CI 1.44-2.58; I 2 = 93%).…”