Influence of Obesity Class on Clinical Outcomes in Alcoholic Hepatitis: A National Cohort Study of Mortality, Complications, and Resource Use

Abstract

Background & Aims

Alcoholic hepatitis (AH) is a severe manifestation of alcoholic liver disease with high morbidity and mortality. This study used the 2016–2020 National Readmission Database to investigate how obesity influences AH outcomes.

Methods

Adult hospitalizations were categorized as those without obesity, Class 1 obesity (BMI 30–34.9), Class 2 obesity (BMI 35–39.9), or Class 3 obesity (BMI ≥ 40). We compared mortality, complications, and resource utilization across these groups using regression models.

Results

Among 82 367 AH admissions, 4.09% had Class 1 obesity, 2.73% had Class 2 obesity, and 4.02% had Class 3 obesity. After adjusting for confounders, Class 3 obesity was associated with higher odds of mortality (Odds ratio OR = 1.74; 95% CI: 1.40–2.17; p < 0.01), septic shock (OR = 2.27; 95% CI: 1.60–3.22; p < 0.01), hepatic encephalopathy (OR = 2.53; 95% CI: 1.15–5.56; p = 0.02), and intensive care unit (ICU) admission (OR = 1.93; 95% CI: 1.57–2.36; p < 0.01). All obesity classes had increased associations with hepatorenal syndrome. No significant differences emerged for spontaneous bacterial peritonitis or variceal bleeding. Resource utilization rose with increasing obesity severity, with Class 3 obesity having a 1.84-day longer adjusted length of stay (p < 0.01) and an additional $20 174 in total hospitalization charges (p < 0.01) compared with hospitalizations without obesity.

Conclusions

Class 3 obesity conferred the greatest burden of mortality, complications, and healthcare costs among hospitalizations with AH. Further research is warranted to clarify the intricate interplay between obesity and AH.