Obesity Has Significant Impact on Mortality in Patients With Acute Alcoholic Hepatitis Fellows-in-Training Award (Obesity Category): Presidential Poster Award

Abstract

Introduction: The prevalence of obesity is rapidly increasing in the United States (US). Obese alcoholic patients are at increased risk for developing cirrhosis and progressive liver failure. However, the impact of obesity on outcomes in patients hospitalized with acute alcoholic hepatitis (AAH) has not been examined. We aimed to evaluate the impact of obesity on mortality and other outcomes in patients hospitalized with AAH. Methods: Adult patients with a principal diagnosis of AAH were selected from the National Inpatient Sample (NIS) database. We studied the period between 2005 and 2014. Patients with an ICD 9 code for acute alcoholic hepatitis - 571.1 - were analyzed. The primary outcome was in-hospital mortality. Secondary outcomes were medical complications (e.g. acute renal failure, acute respiratory failure, hypovolemic shock) and healthcare resource utilization (e.g. length of stay, total hospitalization costs). Multivariable analysis was performed to identify independent predictors of in-hospital mortality after adjusting for confounders. Results: A total of 133,565 patients were hospitalized for AAH; 7,363 (5.5%) of the patients were obese. Demographic information is summarized in Table 1. In-hospital mortality was 5% among obese patients with AAH as compared to 4.1% in non-obese patients (Table 2). After adjusting for confounding variables obese patients with AAH had an increased odds of mortality as compared to non-obese patients [aOR: 1.16, P-value: 0.007]. Obese patients were also more likely to have acute renal failure (p<0.0001), acute respiratory failure (p<0.0001), hypovolemic shock (p<0.0001), coagulopathies (<0.0001), and hepatic encephalopathy (p<0.001). In addition, obese patients with AAH had significantly higher length of stay and hospitalization costs. Other predictors of in-hospital mortality included: younger age, male gender, race, weekend admission, smaller hospital bed-sizes, and urban non-teaching settings (Table:3) Conclusion: Obesity is an independent predictor of in-hospital mortality among patient admitted for AAH. The synergistic relationship between obesity and alcoholic hepatitis puts this patient population at significant risk for multi-organ failure and infection. It is also associated with a significant increase in the cost of hospitalization.1037_A Figure 1. Demographic characteristics1037_B Figure 2. Adverse outcome1037_C Figure 3. Multivariable Analysis