P0958 - Impact of Smoking Cessation Attempts on the Outcomes of Non-Alcoholic Fatty Liver Disease: A Large Population-Based Study

Osama Hamid, MD, MRCPI¹, Khaled Alsabbagh Alchirazi, MD¹, Ahmed Eltelbany, MD, MPH¹, Rama Nanah, MD¹, Jamak Modaresi, MD^2
1Cleveland Clinic, Cleveland, OH; ²Cleveland Clinic Foundation, Cleveland, OH

Introduction: In recent years, NAFLD has emerged as an important liver disease that can lead to non-alcoholic steatohepatitis (NASH), liver cirrhosis, liver failure and hepatocellular cancer. Recent literature suggest that smoking is an independent risk factor for NAFLD. The aim of this study is to evaluate the impact of smoking cessation on the outcomes of NAFLD.

Methods: Using TriNetX, which aggregates over 60 million unique patients’ charts, we identified adults diagnosed with NAFLD with smoking history between 2007 and 2021. We divided this group into two cohorts: smoking cessation attempts and no smoking cessation. A smoking cessation attempt was defined as a smoking cessation counseling visit encounter or a prescription for varenicline/bupropion. We excluded patients with a history of alcoholism, viral hepatitis, or depression. We performed 1:1 Propensity score matching for demographics and NAFLD risk factors like diabetes, hypertension, hyperlipidemia, obesity, hypothyroidism, and OSA. We evaluated NAFLD outcomes like NASH, liver cirrhosis, liver failure, variceal bleed, ascites, hepatocellular carcinoma (HCC) and all-cause mortality. Adjusted odds ratios (aOR) with 95% confidence interval (CI) were calculated to express the risk of each variable.

Results: Out of patients diagnosed with NALFD with history of smoking, we identified 4936 individuals with smoking cessation attempts (mean age 52.8 +/- 12.1) and 40,216 patients with no smoking cessation attempts (mean age 52 +/- 14.4). Females were more likely to attempt smoking cessation (62%), p< 0.001. The majority were white in both groups (cessation attempt 81% vs no attempt 74%). Table 1 summarizes the demographic and risk factors in both groups. After propensity score matching, 4928 patients were compared in each group. The smoking cessation group showed less risk of liver cirrhosis (aOR 0.62 95% CI [0.47-0.85]), NASH (aOR 0.72 95% CI [0.52-0.91]), liver failure (aOR 0.52 95% CI [0.31-0.76]), ascites (aOR 0.56 95% CI [0.43-0.74]), variceal bleed (aOR 0.57 95% CI [0.44-0.75]), and HCC (aOR 0.79 95% CI [0.61-0.96]), Figure 1. On Kaplan Meyer survival analysis, less risk in all-cause mortality is observed in the smoking cessation group (HR 0.59 [0.44-0.79]).

Discussion: In our study, we observed a decreased risk of NASH, liver cirrhosis, liver failure, variceal bleed, ascites, hepatocellular carcinoma and all-cause mortality. Smokers with NAFLD should be strongly encouraged to stop smoking and given all the resources to achieve this goal.




Disclosures:


Osama Hamid, MD, MRCPI¹, Khaled Alsabbagh Alchirazi, MD¹, Ahmed Eltelbany, MD, MPH¹, Rama Nanah, MD¹, Jamak Modaresi, MD². P0958 - Impact of Smoking Cessation Attempts on the Outcomes of Non-Alcoholic Fatty Liver Disease: A Large Population-Based Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.