Association between a Single-time Measurement of Fatty Liver Index and Occurrence of Sepsis among Individuals without Excessive Alcohol Consumption

Abstract

Background Non-alcoholic fatty liver disease is increasing worldwide, and sepsis remains a major global health challenge owing to its high mortality. Given the lack of specific therapeutic agents for sepsis, identifying high-risk populations and implementing preventive measures are critical. This study aimed to investigate the association between a single-time fatty liver index (FLI) measurement and the long-term risk of sepsis. Materials and Methods The cohort included participants from the 2009 Korean National Health Screening Program with no excessive alcohol consumption or acute or chronic liver diseases. The FLI was calculated at baseline and categorized into three groups: low (<30), moderate (30-60), and high (>60). The subjects were followed-up for up to 10 years until sepsis diagnosis or death. Patients with sepsis identified during the washout and one-year lag periods were excluded. Results Of 3,222,171 participants, 64,226 (2.0%) developed sepsis during the follow-up period. The incidence rates per 1,000 person-years in the low-, moderate-, and high-FLI groups were 1.68, 2.52, and 2.58, respectively. In the multivariable Cox regression model, the high-FLI group had a significantly increased risk of sepsis, with an adjusted hazard ratio of 1.52 (95% confidence interval, 1.49-1.55) compared with the low-FLI group. Restricted cubic spline analysis showed a J-shaped nonlinear relationship between FLI and sepsis with increased sepsis risk above an FLI of 23.6. Conclusion This large-scale, long-term observational study demonstrated a significant association between single-time FLI measurement and sepsis risk, highlighting the potential role of FLI in early risk stratification and the prevention of sepsis.