P0943 - Non-Alcoholic Fatty Liver Disease, Congestive Heart Failure and Mortality in Hospitalized Patients With Cirrhosis: The Adiposity Paradox

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

Basile Njei, MD, MPH, PhD

Yale School of Medicine
New Haven, CT

Mouhand FH. Mohamed, MD¹, Derek Ugwendum, MD, MPH², Nso Nso, MD, MPH³, Basile Njei, MD, MPH, PhD⁴
¹Brown University, Providence, RI; ²Richmond University Medical Center, Staten Island, NY; ³University of Chicago Northshore, Evanston, IL; ⁴Yale School of Medicine, New Haven, CT

Introduction: Non-alcoholic fatty liver disease (NAFLD) is increasingly recognized as contributing to cardiovascular morbidity, including congestive heart failure (CHF) risk. This study utilizes a large, nationally representative cohort to assess the impact of NAFLD on CHF risk and mortality in hospitalized patients with cirrhosis.

Methods: We queried the National inpatient sample (NIS) from 2016 to 2020, for hospitalized adult patients (≥18 years) diagnosed with cirrhosis. Primary outcomes of interest were CHF and in-hospital mortality. Secondary outcomes were the length of stay, hospitalization cost, and discharge dispositions. Baseline characteristics were balanced using propensity score matching (PSM). Using Poisson and logistic regressions, adjusted rate and odds ratio (OR) were derived in patients with NAFLD compared to those without NAFLD.

Results: Before PSM, of the 672,625 hospitalized patients with cirrhosis, 4.1% (27,371 patients) were diagnosed with NAFLD. After PSM, 23,161 patients with NAFLD were matched with 23,161 patients without NAFLD (Table 1). Patients in the NAFLD group faced a higher risk of CHF (OR 1.14, 95% confidence interval (CI) 1.10-1.21, p< 0.001), yet paradoxically, they experienced a lower risk of in-hospital mortality (OR 0.57, 95% CI 0.52-0.63, p< 0.001) with overall reduced hospitalization costs (median $24,447 vs. $28,630, OR 0.86, 95% CI 0.85-0.87, p< 0.001, in comparison to those without NAFLD (Figure 1).

Discussion: In this nationwide study of patients with cirrhosis, NAFLD was associated with a higher prevalence of CHF and lower in-patient mortality. These findings mirror the "adiposity paradox" phenomenon, where obese/overweight individuals with cardiometabolic dysfunction may experience less severe or beneficial health outcomes than those with normal weight. Further investigation is warranted to decode the intricate interplay between NAFLD, cirrhosis, CHF, and in-hospital mortality and its clinical practice implications.

Figure: Figure 1: Statistically significant differences were observed in Congestive Heart failure, Mortality, and Discharge Disposition rates between patients with vs. without NAFLD.

	*After Propensity Score Matching*
Variable	NAFLD (N=23,161; 50.0%)	No NAFLD (N=23,161; 50.0%)	*P Value*
Patient Characteristics
Age, median (IQR), y	69 (18)	69 (17)	0.99
Gender
Female	57.8%	58.0%	0.67
Race /Ethnicity
White	76.0%	76.6%	0.45
Black	5.3%	5.3%
Hispanic	13.7%	13.3%
Other	5.0%	4.8%
Charlson Comorbidity Index score
0	6.1%	6.0%	0.55
1-2	10.6%	10.5%
>=3	83.3%	83.5%
*Comorbidities*
Diabetes	43.3%	43.0%	0.40
Hypertension	34.6%	34.9%	0.49
Hyperlipidemia	15.9%	15.3%	0.10
Median household income, $
< 38 999	26.8%	26.3%	0.81
39 000-47 999	27.1%	27.0%
48 000-62 999	24.0%	23.8%
>63 000	22.2%	22.9%
Location/Teaching status
Rural	10.1%	10.3%	0.98
Urban Non-Teaching	39.3%	39.1%
Urban Teaching	50.6%	50.6%
Hospital Size
Small	11.3%	11.1%	0.99
Medium	22.9%	23.0%
Large	65.8%	65.9%

Table: Table 1: Baseline Characteristics of Hospitalized Patients with/without NAFLD after Propensity Score Matching
Abbreviation: IQR, interquartile range, NAFLD, non-alcoholic fatty liver disease. Weighted counts using Nationwide Inpatient Sample complex survey weights; numbers may not sum to group totals, or percentages may not add to 100 owing to the need for rounding. Numbers are rounded to the nearest integral number and percentages are based on rounded numbers.

Disclosures:

Mouhand Mohamed indicated no relevant financial relationships.

Derek Ugwendum indicated no relevant financial relationships.

Nso Nso indicated no relevant financial relationships.

Basile Njei indicated no relevant financial relationships.

Mouhand FH. Mohamed, MD¹, Derek Ugwendum, MD, MPH², Nso Nso, MD, MPH³, Basile Njei, MD, MPH, PhD⁴. P0943 - Non-Alcoholic Fatty Liver Disease, Congestive Heart Failure and Mortality in Hospitalized Patients With Cirrhosis: The Adiposity Paradox, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.