The Impact of Obesity on Inflammatory Cytokines and 90-day and 180-day Survival in Patients With Alcohol-Associated Hepatitis.

INTRODUCTION

Obesity is prevalent in patients with alcohol-associated hepatitis (AH), but its impact on clinical outcomes remains incompletely defined. We aimed to evaluate the association between body mass index (BMI)-defined obesity and 90-day and 180-day survival in AH, as well as its association with complications and circulating inflammatory mediators.

METHODS

We analyzed 778 patients with AH enrolled in the National Institute on Alcohol Abuse and Alcoholism-supported Alcohol-associated Hepatitis Network observational cohort and randomized clinical trial. Patients were categorized as normal weight, overweight, or obese by BMI. Multivariable Cox models were used to evaluate survival. Baseline serum cytokines were measured in a randomly selected subset of 168 patients.

RESULTS

Of the 778 patients, 255 (32.8%) were overweight and 310 (39.8%) were obese. Obese patients had higher baseline Model for End-Stage Liver Disease scores, higher rates of bacterial infection during hospitalization, and higher 90-day and 180-day mortality than overweight and normal-weight patients. In multivariable analysis, obesity was associated with reduced 180-day survival (hazard ratio 1.50; 95% confidence interval [CI] 1.03-2.23, P = 0.041). In adjusted logistic models among severe AH cases, obesity remained associated with infection (odds ratio 1.84; 95% CI 1.15-2.93; P = 0.011) and acute kidney injury (odds ratio 2.25; 95% CI 1.42-3.57; P = 0.0005) within 180 days. In the cytokine subset, obese patients showed higher levels of proinflammatory cytokines and chemokines and lower levels of growth factors.

DISCUSSION: Obesity in AH was associated with more severe disease at presentation, increased risk of complications, and worse survival, supporting obesity as an important adverse factor in AH.