The impact of obesity on inflammatory cytokines and 90- and 180-day survival in patients with alcohol-associated hepatitis
Yun-Cheng Hsieh, Mrigya Babuta, Hannah Siegenberg, Prashanth Thevkar Nagesh, Yunpeng Yu, Wanzhu Tu, Richard K Sterling, Gyongyi Szabo,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 BMI-defined obesity and 90- 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 NIAAA-supported Alcoholic Hepatitis Network (AlcHepNet) 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 MELD scores, higher rates of bacterial infection during hospitalization, and higher 90- and 180-day mortality than overweight and normal-weight patients. In multivariable analysis, obesity was associated with reduced 180-day survival (HR 1.50; 95% CI 1.03–2.23, p = 0.041). In adjusted logistic models among severe AH cases, obesity remained associated with infection (OR 1.84; 95% CI 1.15–2.93; p = 0.011) and AKI (OR 2.25; 95% CI 1.42–3.57; p = 0.0005) within 180 days. In the cytokine subset, obese patients showed higher levels of pro-inflammatory cytokines and chemokines and lower levels of growth factors.
Conclusions:
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.