Baseline and Longitudinal MASLD Status Is Associated with Increased Risk of Pyogenic Liver Abscess.

BACKGROUND/AIMS: Pyogenic liver abscess (PLA) is a severe infectious disease with significant morbidity and mortality risk. We investigated the association between metabolic dysfunction-associated steatotic liver disease (MASLD) and the incidence of PLA and related complications. METHODS: We analyzed data from 2,951,003 adults aged 40 to 64 years who underwent health examinations between 2009 and 2010 using the Korean National Health Insurance Service database. Hepatic steatosis was defined as a fatty liver index ≥30, and MASLD was identified based on established criteria. Changes in MASLD status over a 4-year follow-up period were evaluated for their impact on PLA risk. RESULTS: Over a median follow-up of more than 14 years, the incidence rate of PLA was 27.2 per 100,000 person-years versus 13.3 per 100,000 person-years in the MASLD and non-steatotic liver disease (non-SLD) groups, respectively. Compared to non-SLD, MASLD was significantly associated with an increased risk of PLA (hazard ratio [HR], 1.53; 95% confidence interval [CI], 1.45 to 1.61) and its complications (HR, 1.72; 95% CI, 1.27 to 2.33). In the 4-year follow-up analysis, compared to individuals without any SLD at both baseline and follow-up, individuals with persistent MASLD had a higher risk of PLA (HR, 1.61; 95% CI, 1.49 to 1.74), followed by those whose MASLD regressed to non-SLD (HR, 1.38; 95% CI, 1.23 to 1.53) and those who developed MASLD during follow-up (HR, 1.27; 95% CI, 1.13 to 1.43). Other metabolic SLD categories also showed a higher risk of PLA than the non-SLD group. CONCLUSIONS: MASLD is significantly associated with an increased risk of PLA and related complications, with the highest risk observed in individuals with persistent MASLD.