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Impact of metabolic risk factors on the severity and outcome of patients with alcohol‐associated acute‐on‐chronic liver failure
Author(s) -
Duseja Ajay,
De Arka,
Taneja Sunil,
Choudhury Ashok Kumar,
Devarbhavi Harshad,
Hu Jinhua,
Hamid Saeed S.,
Butt Amna Subhan,
Jafri Syed Muhammad Wasim,
Ghazinian Hasmik,
Chawla Yogesh K.,
Dhiman Radha K.,
Duan Zhongping,
Chen Yu,
Tan Soek Siam,
Lee Guan Huei,
Lim Seng Gee,
Kim Dong Joon,
Sahu Manoj,
Sollano Jose D.,
Carpio Gian,
Mohan Prasad Virukalpatti Gopalratnam,
Abbas Zaigham,
Lesmana Laurentius A.,
Lesmana Cosmas Rinaldi,
Eapen Chundamannil E.,
Goel Ashish,
Sood Ajit,
Midha Vandana,
Goyal Omesh,
Dokmeci Abdul Kadir,
Ning Qin,
Chen Tao,
Ma Ke,
Payawal Diana A.,
Lau George K. K.,
Al Mahtab Mamun,
Rahman Salimur,
Alam Mohd Shahinul,
Shukla Akash,
Shrestha Ananta,
Shah Samir,
Kalal Chetan Ramesh,
Kumar Guresh,
Jain Priyanka,
Paulson Irene,
Sarin Shiv Kumar
Publication year - 2021
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.14671
Subject(s) - medicine , overweight , obesity , diabetes mellitus , liver disease , chronic liver disease , risk factor , gastroenterology , cirrhosis , endocrinology
Background Metabolic risk factors may impact the severity and outcome of alcoholic liver disease. The present study evaluated this effect in patients with alcohol‐associated acute‐on‐chronic liver failure (ACLF). Methodology One thousand two hundred and sixteen prospectively enrolled patients with ACLF (males 98%, mean age 42.5 ± 9.4 years, mean CTP, MELD and AARC scores of 12 ± 1.4, 29.7 ± 7 and 9.8 ± 2 respectively) from the Asian Pacific Association for the Study of the Liver (APASL) ACLF Research Consortium (AARC) database were analysed retrospectively. Patients with or without metabolic risk factors were compared for severity (CTP, MELD, AARC scores) and day 30 and 90 mortality. Information on overweight/obesity, type 2 diabetes mellitus (T2DM), hypertension and dyslipidaemia were available in 1028 (85%), 1019 (84%), 1017 (84%) and 965 (79%) patients respectively. Results Overall, 392 (32%) patients died at day 30 and 528 (43%) at day 90. Overweight/obesity, T2DM, hypertension and dyslipidaemia were present in 154 (15%), 142 (14%), 66 (7%) and 141 (15%) patients, respectively, with no risk factors in 809 (67%) patients. Patients with overweight/obesity had higher MELD scores (30.6 ± 7.1 vs 29.2 ± 6.9, P = .007) and those with dyslipidaemia had higher AARC scores (10.4 ± 1.2 vs 9.8 ± 2, P = .014). Overweight/obesity was associated with increased day 30 mortality (HR 1.54, 95% CI 1.06‐2.24, P = .023). None of other metabolic risk factors, alone or in combination, had any impact on disease severity or mortality. On multivariate analysis, overweight or obesity was significantly associated with 30‐day mortality (aHR 1.91, 95% CI 1.41‐2.59, P < .001), independent of age, CTP, MELD and AARC scores. Conclusion Overweight/obesity and dyslipidaemia increase the severity of alcohol‐associated ACLF, and the former also increases the short‐term mortality in these patients.