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Non-alcoholic fatty liver disease and 30-day all-cause mortality in adult patients with community-acquired pneumonia

Background
Non-alcoholic fatty liver disease (NAFLD) is a common and serious form of chronic liver disease. Risk factors of NAFLD include obesity and type 2 diabetes which are associated with infections.


Aim
We aimed to determine the association of NAFLD with 30-day all-cause mortality in adult patients with community-acquired pneumonia (CAP).


Methods
A retrospective cohort study on hospitalized patients with CAP that was conducted during a period of 4 years. We included patients aged ≥18 years with CAP who underwent abdominal ultrasonography. We compared between patients with and without NAFLD in term of age, gender, body mass index (BMI), comorbidities, CURB-65, pneumonia severity index (PSI), liver enzymes, C-reactive protein (CRP) and 30-day all-cause mortality. We used fibrosis score to distinguish between patients with NAFLD who have advanced fibrosis (F3-F4) and do not have (F0-F2).


Results
A total of 561 patients were included in this study. The overall prevalence of NAFLD was 200/561 (35.6%). Significant differences were found between the groups with and without NAFLD in term of BMI, CURB-65, ALT, GGT and CRP. The 30-day all-cause mortality rate was 9.8% (55/561). Among the NAFLD group 34/200 (17%) subjects died vs. 21/361 (5.82%) among patients without NAFLD, P < 0.001. Multi-variate logistic regression analysis after adjusting for other multiple covariates showed that NAFLD with fibrosis score 0-2 [odds ratio (OR) 1.38, 95% confidence interval (CI) 1.12-1.51, P = 0.04], NAFLD with fibrosis score> 2 (1.52; 1.25-1.70, P = 0.03) were associated with 30-day all-cause mortality among patients with CAP.


Conclusions
NAFLD was associated with 30-day all-cause mortality in patients with CAP. This association was more significant in patients with advanced hepatic fibrosis.