In the Journals

Morbid obesity increases risk for acute-on-chronic liver failure

Patients with class III obesity have an increased risk for acute-on-chronic liver failure and a higher prevalence of renal failure as a component of ACLF, according to a recently published study.

“We propose that the link between class III obesity and increased risk of ACLF is due to an obesity-related chronic inflammatory state,” Vinay Sundaram, MD, from the Cedars-Sinai Medical Center, California, and colleagues wrote. “Given the high mortality and health care burden associated with obesity, along with its rising prevalence among patients with cirrhosis, we suggest an even greater emphasis on weight reduction among cirrhotic patients with class III obesity.”

To evaluate the correlation between obesity and ACLF, Sundaram and colleagues analyzed data of liver transplant waitlist patients from the United Network for Organ Sharing and patients from the Nationwide Inpatient Sample (NIS) database. Patients included in the study were adults with decompensated cirrhosis who had at least one decompensating event such as ascites, hepatic encephalopathy or variceal hemorrhage.

The researchers categorized patients as without obesity (BMI < 30 kg/m2), having class I or II obesity (BMI between 30 kg/m2 and 30.9 kg/m2), or having class 3 obesity (BMI > 40 kg/m2).

Among patients from the UNOS database, ACLF at the time of waitlist registration was significantly more prevalent among patients with class III obesity (23.1%; P < .001) compared with patients without obesity (15.9%) and those with class I or II obesity (16.5%).

Multivariate analysis showed that class I or II obesity (HR = 1.12; 95% CI, 1.05-1.19) and class III obesity (HR = 1.24; 95% CI, 1.09-1.41) significantly correlated with ACLF at time of liver transplantation. Additionally, the prevalence of renal failure as a component of ACLF increased significantly with increasing obesity class (P < .001).

The researchers found similar results among the patients from the NIS database, in that ACLF was significantly more prevalent among patients with class III obesity (45.1%; P < .001) compared with patients without obesity (37.6%) and those with class I or II obesity (38.8%), and that the prevalence of renal failure increased with increasing obesity class.

Multivariate analysis of the NIS data showed that, compared with patients without obesity, class III obesity correlated with ACLF (OR = 1.3; 95% CI, 1.25-1.35).

Additional factors associated with ACLF included age between 40 years and 65 years (OR = 1.12; 95% CI, 1.07-1.17) and older than 65 years (OR = 1.07; 95% CI, 1.03-1.12), African-American race (OR = 1.37; 95% CI, 1.34-1.41), alcoholic cirrhosis (OR = 1.14; 95% CI, 1.12-1.16), anemia (OR = 1.76; 95% CI, 1.73-1.81), presence of ascites (OR = 1.89; 95% CI, 1.88-1.91), and Charlson category 2 (OR = 1.53; 95% CI, 1.5-1.56) or category 3 (OR = 3.13; 95% CI, 3.04-3.21).

“For patients unable to reach their weight loss goals via lifestyle modifications alone, bariatric surgery may be an effective preventative measure,” Sundaram and colleagues wrote. “It should be noted, however, that obese patients may also be sarcopenic, and weight loss strategies should be implemented in conjunction with an assessment of nutritional status, to avoid worsening protein calorie malnutrition.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.

Patients with class III obesity have an increased risk for acute-on-chronic liver failure and a higher prevalence of renal failure as a component of ACLF, according to a recently published study.

“We propose that the link between class III obesity and increased risk of ACLF is due to an obesity-related chronic inflammatory state,” Vinay Sundaram, MD, from the Cedars-Sinai Medical Center, California, and colleagues wrote. “Given the high mortality and health care burden associated with obesity, along with its rising prevalence among patients with cirrhosis, we suggest an even greater emphasis on weight reduction among cirrhotic patients with class III obesity.”

To evaluate the correlation between obesity and ACLF, Sundaram and colleagues analyzed data of liver transplant waitlist patients from the United Network for Organ Sharing and patients from the Nationwide Inpatient Sample (NIS) database. Patients included in the study were adults with decompensated cirrhosis who had at least one decompensating event such as ascites, hepatic encephalopathy or variceal hemorrhage.

The researchers categorized patients as without obesity (BMI < 30 kg/m2), having class I or II obesity (BMI between 30 kg/m2 and 30.9 kg/m2), or having class 3 obesity (BMI > 40 kg/m2).

Among patients from the UNOS database, ACLF at the time of waitlist registration was significantly more prevalent among patients with class III obesity (23.1%; P < .001) compared with patients without obesity (15.9%) and those with class I or II obesity (16.5%).

Multivariate analysis showed that class I or II obesity (HR = 1.12; 95% CI, 1.05-1.19) and class III obesity (HR = 1.24; 95% CI, 1.09-1.41) significantly correlated with ACLF at time of liver transplantation. Additionally, the prevalence of renal failure as a component of ACLF increased significantly with increasing obesity class (P < .001).

The researchers found similar results among the patients from the NIS database, in that ACLF was significantly more prevalent among patients with class III obesity (45.1%; P < .001) compared with patients without obesity (37.6%) and those with class I or II obesity (38.8%), and that the prevalence of renal failure increased with increasing obesity class.

Multivariate analysis of the NIS data showed that, compared with patients without obesity, class III obesity correlated with ACLF (OR = 1.3; 95% CI, 1.25-1.35).

Additional factors associated with ACLF included age between 40 years and 65 years (OR = 1.12; 95% CI, 1.07-1.17) and older than 65 years (OR = 1.07; 95% CI, 1.03-1.12), African-American race (OR = 1.37; 95% CI, 1.34-1.41), alcoholic cirrhosis (OR = 1.14; 95% CI, 1.12-1.16), anemia (OR = 1.76; 95% CI, 1.73-1.81), presence of ascites (OR = 1.89; 95% CI, 1.88-1.91), and Charlson category 2 (OR = 1.53; 95% CI, 1.5-1.56) or category 3 (OR = 3.13; 95% CI, 3.04-3.21).

“For patients unable to reach their weight loss goals via lifestyle modifications alone, bariatric surgery may be an effective preventative measure,” Sundaram and colleagues wrote. “It should be noted, however, that obese patients may also be sarcopenic, and weight loss strategies should be implemented in conjunction with an assessment of nutritional status, to avoid worsening protein calorie malnutrition.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.