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Obesity paradox in advanced liver disease: obesity is associated with lower mortality in hospitalized patients with cirrhosis
Author(s) -
Karagozian Raffi,
Bhardwaj Gaurav,
Wakefield Dorothy B.,
Baffy Gyorgy
Publication year - 2016
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13137
Subject(s) - obesity , medicine , cirrhosis , disease , liver disease , obesity paradox , gastroenterology , overweight
Background & Aims To investigate how obesity impacts inpatient mortality, length of stay ( LOS ) and costs in patients with cirrhosis. Obesity is a growing epidemic associated with multiple co‐morbidities, increased morbidity, and a significant economic burden on healthcare. Despite the overall harmful impact of obesity, the ‘obesity paradox’ has been described as decreased mortality among obese vs non‐obese patients in various chronic medical conditions. Methods Analysis of the Nationwide Inpatient Sample ( NIS ) for 2012, which contains data from 44 states and 4378 hospitals. Data from all cases with primary, secondary or tertiary discharge diagnosis of cirrhosis identified by International Classification of Diseases‐9 code 571.2, 571.5 571.6 were included. Primary outcomes included inpatient mortality, LOS , and hospital charges. Obesity as a predictor of mortality was defined by a predetermined obesity co‐morbidity variable. Results A total of 32,605 patients were included. Crude mortality was lower for obese cirrhotic patients (2.7% vs 3.5%, P = 0.02) than for non‐obese cirrhotic patients. In contrast, median LOS was longer (4 vs 3 days, P < 0.001) and median hospital charges were higher for obese cirrhotic patients ($26 803 vs $23 447, P < 0.001) In multivariate logistic regression, obesity was associated with a lower risk of inpatient mortality ( OR =0.73, 95% CI : 0.55–0.95, P = 0.02). Conclusions In the acute care setting, obese patients with cirrhosis have lower mortality than non‐obese patients with cirrhosis, longer hospitalizations and higher healthcare cost, providing new evidence for the obesity paradox in cirrhosis. Obese cirrhotic patients are more likely to have enhanced nutritional reserve which may play a role in survival during acute illness.