Biopsy-proven NAFLD patients face a higher hospitalization risk for severe infections than their siblings and the general population.

A population-based cohort study aimed to evaluate the chance of severe infection in individuals with biopsy-proven non-alcoholic fatty liver disease (NAFLD).

A total of 12,133 adults with histologically confirmed NAFLD were involved. The NAFLD cases comprised individuals with simple steatosis (n = 8232), nonfibrotic steatohepatitis (n = 1378), noncirrhotic fibrosis (n = 1845), and cirrhosis (n = 678). They were matched to 57,516 (≤5) population comparators based on county, calendar year, sex, and age. Incident serious infections requiring hospitalization were tracked using Swedish national registers. To calculate hazard ratios for NAFLD and its histopathological subgroups, the utilization of multivariable-adjusted Cox regression was done.

Over a period of approximately 14.1 years, 37.2% of individuals with NAFLD (n=4517) compared to 26.2% of comparators (n=15,075) were hospitalized for severe infections. Individuals diagnosed with NAFLD experienced a notably higher occurrence of severe infections compared to the comparators (32.3 vs. 17.0 per 1000 person-years), with an adjusted hazard ratio (aHR) of 1.71. The most common types of infections observed were respiratory infections (13.8 per 1000 person-years) and urinary tract infections (11.4 per 1000 person-years).

The absolute risk difference observed twenty years after diagnosing NAFLD amounted to 17.3%, indicating an additional severe infection in every 6 patients suffering from NAFLD. The risk of severe infection showed a correlation with the severity of NAFLD based on histological findings, with higher risks observed for cirrhosis (aHR, 2.32), noncirrhotic fibrosis (aHR, 1.77), nonfibrotic steatohepatitis (aHR, 1.84), and simple steatosis (aHR, 1.64). Additionally, when compared to their full siblings, people with NAFLD had a heightened risk of severe infections (aHR, 1.54).

The presence of NAFLD was linked with an elevated likelihood of severe infections that necessitated hospitalization. This heightened risk was not only noticeable when related to the general population but also when compared to their own siblings. Moreover, the risk of severe infection was found to increase as the severity of NAFLD progressed through its different stages.