Non-Alcoholic Fatty Liver Disease is Associated with an Increased Mortality in Adult Patients with Group B Streptococcus Invasive Disease

Abstract

Background: Group B Streptococcus (GBS) is a significant cause of invasive disease among adult non-pregnant patients with increasing incidence and mortality rates. Although non-alcoholic fatty liver disease (NAFLD) is associated with components of metabolic syndrome previously recognized as risk factors for GBS, the impact of NAFLD on GBS course and outcomes is unknown. Methods: We conducted a retrospective cohort study of all non-pregnant adult patients diagnosed with invasive GBS infection during a 15-year period. Results: 102 patients were included in the study (46.1% males; median age 69, IQR 58-78 years). Disease primarily presented as bacteremia without a defined source (37; 36.3%), cellulitis/erysipelas (35; 34.3%), pneumonia (13; 12.7%) and endocarditis (8; 7.8%). The most common comorbidities were diabetes (42; 41.2%), dyslipidemia (39; 38.2%), cardiovascular disease (34; 33.3%), peripheral vascular disease (21; 20.6%), obesity (21; 20.6%) and malignancy (10; 9.8%). Based upon the results of abdominal ultrasound, the patients were divided into two groups: the ones with steatosis (44; 43.1%) and the ones without steatosis (58; 56.9%). There were no significant differences in clinical presentations and comorbidities between groups. In-hospital mortality was 29.5% (13/44) in patients with NAFLD and 10.3% (6/58) in the control group (p=0.0200). Endocarditis (OR 6.69; 95%CI 1.045-44.46, p=0.0410), acute renal failure (OR 13.92; 95%CI 3.00-77.71, p=0.0013), qSOFA > 2 (OR 23.93; 95%CI 4.66-171.2) and NAFLD (OR 6.64; 95%CI 1.23-47.88, p=0.0258) were independently associated with in-hospital mortality. Conclusions: NAFLD is associated with higher mortality in patients suffering from invasive GBS disease which appears to be independent of other components of the metabolic syndrome, such as obesity and diabetes mellitus.

The Impact of Nonalcoholic Fatty Liver Disease on Severe Community-Acquired Pneumonia Outcomes

“…Notably, patients with NAFLD more frequently developed AKI and required CRRT, reflecting a more severe disease. Similar was described in a cohort of patients with invasive group B streptococcus infections and NAFLD [ 25 ].…”

“…In the pre-COVID era, data associating NAFLD with adverse outcomes in serious infections were scarce, although consistent [ 20 , 21 , 22 , 23 , 24 , 25 ]. In COVID-19, numerous studies reported an association of NAFLD with increased COVID-19 severity and mortality [ 26 , 27 , 28 , 29 ].…”

Nonalcoholic Fatty Liver Disease—A Novel Risk Factor for Recurrent Clostridioides difficile Infection

“…Although patients with NAFLD might have a higher risk for infections due to the concomitant presence of obesity or diabetes mellitus, few studies that included NAFLD in the analysis consistently showed its outcome impact independently of the metabolic syndrome components [20]. So far, this was suggested for communityacquired pneumonia, bacteriaemia of gastrointestinal origin, sepsis and urinary tract infections [21][22][23][24][25]. Recently, we have shown that NAFLD is a risk factor for in-hospital CDI development in elderly patients treated with systemic antimicrobial therapy [16].…”

The Role of Non-Alcoholic Fatty Liver Disease in Infections

“…Acute renal failure, qSOFA ≥ 2, endocarditis, and NAFLD were all independently linked to in-hospital mortality. The study concluded that NAFLD is associated with higher mortality in individuals with invasive GBS disease [67]. These studies did not stratify the severity of liver disease and its correlation with the severity of bacteremia, RBIs and their outcome.…”