Journal of general internal medicine · 2025
Clinical Outcomes in Acute Decompensated Metabolic Dysfunction-associated Steatotic Liver Disease Cirrhosis: The Role of BMI in Mortality, Readmission, and Hospital Stay.
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Gade Ajay, Papudesi Bhavani N, Joseph Sam
Аннотация
BACKGROUND: This study examines the impact of Body Mass Index (BMI) on mortality, readmission rates, and hospital stay lengths in patients with acute decompensated non-alcoholic fatty liver cirrhosis, now termed metabolic dysfunction-associated steatotic liver disease (MASLD).
OBJECTIVE: To assess the relationship between BMI and outcomes such as mortality, readmission rates, and hospital and ICU lengths of stay in patients with acute decompensated MASLD.
DESIGN: Retrospective cohort analysis.
PARTICIPANTS: Conducted at Grand Strand Medical Center, Myrtle Beach, SC, this study included 43,942 patients, using data from the Hospital Corporation of America Enterprise Data Warehouse from 2017-2022.
MAIN MEASURES: Logistic regression and negative binomial models were used, adjusting for age, gender, race, diabetes, and hyperlipidemia.
KEY RESULTS: A notable "obesity paradox" was observed: underweight patients had over twice the odds of mortality (OR = 2.12, 95% CI: 1.83-2.46; p < 0.0001) compared to healthy-weight patients, suggesting a protective effect of higher BMI. While BMI did not significantly affect overall readmission, patients with Class III obesity had lower readmission odds (OR = 0.86, 95% CI: 0.77-0.96; p = 0.0012). However, Class III obesity was linked to increased hospital (IRR = 1.20, 95% CI: 1.15-1.26; p < 0.0001) and ICU LOS (IRR = 1.12, 95% CI: 1.04-1.20; p < 0.0001). Diabetes (IRR = 1.09, 95% CI: 1.06-1.11) and hyperlipidemia (IRR = 1.34, 95% CI: 1.31-1.38) were also associated with longer LOS (p < 0.0001).
CONCLUSION: These findings highlight the complexity of BMI's role in MASLD outcomes. The observed obesity paradox warrants further investigation to inform care strategies across BMI categories.
OBJECTIVE: To assess the relationship between BMI and outcomes such as mortality, readmission rates, and hospital and ICU lengths of stay in patients with acute decompensated MASLD.
DESIGN: Retrospective cohort analysis.
PARTICIPANTS: Conducted at Grand Strand Medical Center, Myrtle Beach, SC, this study included 43,942 patients, using data from the Hospital Corporation of America Enterprise Data Warehouse from 2017-2022.
MAIN MEASURES: Logistic regression and negative binomial models were used, adjusting for age, gender, race, diabetes, and hyperlipidemia.
KEY RESULTS: A notable "obesity paradox" was observed: underweight patients had over twice the odds of mortality (OR = 2.12, 95% CI: 1.83-2.46; p < 0.0001) compared to healthy-weight patients, suggesting a protective effect of higher BMI. While BMI did not significantly affect overall readmission, patients with Class III obesity had lower readmission odds (OR = 0.86, 95% CI: 0.77-0.96; p = 0.0012). However, Class III obesity was linked to increased hospital (IRR = 1.20, 95% CI: 1.15-1.26; p < 0.0001) and ICU LOS (IRR = 1.12, 95% CI: 1.04-1.20; p < 0.0001). Diabetes (IRR = 1.09, 95% CI: 1.06-1.11) and hyperlipidemia (IRR = 1.34, 95% CI: 1.31-1.38) were also associated with longer LOS (p < 0.0001).
CONCLUSION: These findings highlight the complexity of BMI's role in MASLD outcomes. The observed obesity paradox warrants further investigation to inform care strategies across BMI categories.