Obesity Increases Mortality, Complication Risk in Alcohol-Associated Hepatitis

New research is shedding light on the prevalence of obesity among patients with alcohol-associated hepatitis (AH) and its impact on clinical outcomes.1

Leveraging data from the 2016–2020 National Readmission Database, the study found Class 3 obesity conferred a greater risk of mortality, complications, and healthcare costs among AH hospitalizations than patients with a body mass index (BMI) < 30.1

According to the US Centers for Disease Control and Prevention, the prevalence of obesity among US adults ≥ 20 years of age was 41.9% during 2017–March 2020.2 Compared to those with a healthy weight, people with obesity are at increased risk of several diseases and health conditions, including high blood pressure, high cholesterol, type 2 diabetes, and breathing problems like asthma and sleep apnea.3 Emerging evidence suggests obesity may work synergistically with alcohol to damage hepatic cells, posing important implications for liver-related health and outcomes.1

“In light of the increasing prevalence of obesity and the paucity of clinical data on its influence on AH outcomes, it is crucial to comprehend this relationship,” Ali Jaan, MD, internal medicine chief resident at Rochester General Hospital, and colleagues wrote.1

To determine how obesity influences AH outcomes, investigators conducted a retrospective cohort study utilizing data from the National Readmission Database, the largest publicly available all-payer inpatient healthcare database, covering 31 states and > 60% of the US population. They included adult hospitalizations with a principal diagnosis of AH utilizing ICD-10-CM codes and classified these hospitalizations into 4 groups based on the presence and severity of obesity:

• Non-obese: BMI < 30
• Class 1 obesity: BMI 30–34.9
• Class 2 obesity: BMI 35–39.9
• Class 3 obesity: BMI ≥ 40

Hospitalizations without obesity were used as references for statistical analysis. The primary outcome was all-cause mortality, while secondary outcomes included septic shock, vasopressor requirement, need for mechanical ventilation, and admission to the intensive care unit (ICU). Investigators also assessed AH-specific complications and resource utilization.1

Among 82,367 AH admissions, 4.09% had Class 1 obesity, 2.73% had Class 2 obesity, and 4.02% had Class 3 obesity. Investigators noted patients with Class 3 obesity demonstrated the greatest unadjusted in-hospital mortality rate (5.40%) compared with non-obese individuals (3.15%), as well as those with Class 1 (3.26%) and Class 2 obesity (2.15%).1

After adjusting for confounders, Class 3 obesity was significantly associated with increased odds of in-hospital mortality (adjusted odds ratio [aOR], 1.74; 95% CI, 1.40–2.17; P <.01). Further analysis revealed Class 3 obesity was also associated with elevated risks of septic shock (aOR, 2.27; 95% CI, 1.60–3.22; P <.01), mechanical ventilation (aOR, 2.02; 95% CI, 1.63–2.49; P <.01), ICU admission (aOR, 1.93; 95% CI, 1.57–2.36; P <.01), and vasopressor use (aOR, 1.73; 95% CI, 1.09–2.73; P = .02).1

While hepatorenal syndrome was more frequent across all obesity classes, hepatic encephalopathy was only significantly increased in patients Class 3 obesity (aOR, 2.53; 95% CI, 1.15–5.56; P = .02). Investigators did not observe any significant differences for spontaneous bacterial peritonitis or variceal bleeding.1

For resource utilization, the mean length of stay (LOS) increased from 6.23 days in patients without obesity to 8.39 days in those with Class 3 obesity. In adjusted analyses, Class 3 obesity was associated with a mean LOS increase of 1.84 days (P < 0.01).1

Investigators pointed out total hospitalization charges also climbed markedly in Class 3 obesity, with an adjusted increase of $20,174 (P <.01) compared with hospitalizations without obesity. Additionally, Class 3 obesity was linked to a reduced likelihood of home discharge (aOR, 0.68; 95% CI, 0.61–0.76; P <.01) and a greater probability of discharge to rehabilitation facilities (aOR, 1.65; 95% CI, 1.40–1.95; P <.01).1

“These findings underscore the importance of addressing and managing obesity in patients with AH, not only for its potential contribution to mortality but also due to its association with a spectrum of complications and increased healthcare resource utilization,” investigators concluded.1 “Further research is crucial for a comprehensive understanding of the intricate impact of obesity on AH severity and outcomes. This knowledge will inform better clinical management and resource allocation across diverse healthcare settings.”

References

1. Jaan A, Najim MS, Farooq U, et al. Influence of Obesity Class on Clinical Outcomes in Alcoholic Hepatitis: A National Cohort Study of Mortality, Complications, and Resource Use. JGH Open. https://doi.org/10.1002/jgh3.70166

2. US Centers for Disease Control and Prevention. Adult Obesity Facts. May 14, 2024. Accessed April 17, 2025. https://www.cdc.gov/obesity/adult-obesity-facts/index.html

3. US Centers for Disease Control and Prevention. Consequences of Obesity. July 15, 2022. Accessed April 17, 2025. https://www.cdc.gov/obesity/basics/consequences.html