Ajay Duseja1, Arka De1, Sunil Taneja1, Ashok Kumar Choudhury2, Harshad Devarbhavi3, Jinhua Hu4, Saeed S Hamid5, Amna Subhan Butt5, Syed Muhammad Wasim Jafri5, Hasmik Ghazinian6, Yogesh K Chawla1, Radha K Dhiman1, Zhongping Duan7, Yu Chen7, Soek Siam Tan8, Guan Huei Lee9, Seng Gee Lim10, Dong Joon Kim11, Manoj Sahu12, Jose D Sollano13, Gian Carpio14, Virukalpatti Gopalratnam Mohan Prasad15, Zaigham Abbas16, Laurentius A Lesmana17, Cosmas Rinaldi Lesmana17, Chundamannil E Eapen18, Ashish Goel18, Ajit Sood19, Vandana Midha19, Omesh Goyal19, Abdul Kadir Dokmeci20, Qin Ning21, Tao Chen21, Ke Ma21, Diana A Payawal22, George K K Lau23, Mamun Al Mahtab24, Salimur Rahman25, Mohd Shahinul Alam25, Akash Shukla24, Ananta Shrestha26, Samir Shah27, Chetan Ramesh Kalal27, Guresh Kumar28, Priyanka Jain28, Irene Paulson2, Shiv Kumar Sarin2. 1. Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. 2. Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India. 3. Department of Gastroenterology, St John's Medical College Hospital, Bangalore, India. 4. Liver Failure Treatment and Research Center, 302 Military Hospital of China, Beijing, China. 5. The Aga Khan University, Karachi, Pakistan. 6. Department of Hepatology, Nork Clinical Hospital of Infectious Diseases, Yerevan, Armenia. 7. Beijing Youan Hospital, Capital Medical University, Beijing, China. 8. Department of Hepatology, Selayang Hospital, Selangor, Malaysia. 9. Division of Gastroenterology and Hepatology, National University Health System, Singapore. 10. Medicine, Yong Loo Lin School of Medicine, Singapore. 11. Hallym University Medical Center, Seoul, Korea. 12. ISM and SUM Hospital, Bhubaneswar, India. 13. Medicine, Santo Tomas, Manila, Philippines. 14. University of Santo Tomas, Manila, Philippines. 15. VGM Hospital, Coimbatore, India. 16. Department of Hepatogastroenterology, Ziauddin University, Karachi, Pakistan. 17. Medicine, Medistra Hospital, South Jakarta, Indonesia. 18. Christian Medical College, Vellore, India. 19. Dayanand Medical College and Hospital, Ludhiana, India. 20. Department of Gastroenterology, Ankara University, Ankara, Turkey. 21. Tongji Medical College, Wuhan, China. 22. Cardinal Santos Medical Center, San Juan, Philippines. 23. Humanity and Health Medical Centre, Hong Kong. 24. Seth GS Medical College & Kem Hospital, Mumbai, India. 25. Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. 26. Foundation Nepal Sitapaila Height, Kathmandu, Nepal. 27. Hepatology, Global Hospital, Mumbai, India. 28. Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India.
Abstract
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.
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%) patientsdied 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.
Authors: D Morales-Arráez; M Ventura-Cots; J Altamirano; J G Abraldes; M Cruz-Lemini; M R Thursz; S R Atkinson; S K Sarin; W Kim; R Chavez-Araujo; M F Higuera-de la Tijera; A K Singal; V H Shah; P S Kamath; A Duarte-Rojo; E A Charles; V Vargas; M Jager; P E Rautou; D Rincon; F Zamarripa; J C Restrepo-Gutiérrez; A Torre; M R Lucey; J P Arab; P Mathurin; A Louvet; G García-Tsao; J A González; E C Verna; R S Brown; J Argemi; C Fernández-Carrillo; A Clemente; E Alvarado-Tapias; E Forrest; M Allison; R Bataller Journal: Am J Gastroenterol Date: 2022-02-01 Impact factor: 12.045