Raffi Karagozian1, Gaurav Bhardwaj2, Dorothy B Wakefield3, Gyorgy Baffy4. 1. School of Medicine, University of Connecticut, Farmington, CT, USA. raffikaragozian@gmail.com. 2. School of Medicine, University of Connecticut, Farmington, CT, USA. 3. Center for Public Health and Health Policy, UConn Health, Farmington, CT, USA. 4. Division of Gastroenterology & Hepatology, VA Boston Healthcare System, Harvard Medical School, Boston, MA, USA.
Abstract
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.
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-obesepatients 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 cirrhoticpatients (2.7% vs 3.5%, P = 0.02) than for non-obese cirrhoticpatients. In contrast, median LOS was longer (4 vs 3 days, P < 0.001) and median hospital charges were higher for obese cirrhoticpatients ($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, obesepatients with cirrhosis have lower mortality than non-obesepatients with cirrhosis, longer hospitalizations and higher healthcare cost, providing new evidence for the obesity paradox in cirrhosis. Obese cirrhoticpatients are more likely to have enhanced nutritional reserve which may play a role in survival during acute illness.
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