Influence of Obesity Class on Clinical Outcomes in Alcoholic Hepatitis: A National Cohort Study of Mortality, Complications, and Resource Use.

Background & Aims: Alcoholic hepatitis (AH) is a severe manifestation of alcoholic liver disease with high morbidity and mortality. This study used the 2016-2020 National Readmission Database to investigate how obesity influences AH outcomes.

Methods: Adult hospitalizations were categorized as those without obesity, Class 1 obesity (BMI 30-34.9), Class 2 obesity (BMI 35-39.9), or Class 3 obesity (BMI ≥ 40). We compared mortality, complications, and resource utilization across these groups using regression models.

Results: Among 82 367 AH admissions, 4.09% had Class 1 obesity, 2.73% had Class 2 obesity, and 4.02% had Class 3 obesity. After adjusting for confounders, Class 3 obesity was associated with higher odds of mortality (Odds ratio OR = 1.74; 95% CI: 1.40-2.17;  < 0.01), septic shock (OR = 2.27; 95% CI: 1.60-3.22;  < 0.01), hepatic encephalopathy (OR = 2.53; 95% CI: 1.15-5.56;  = 0.02), and intensive care unit (ICU) admission (OR = 1.93; 95% CI: 1.57-2.36;  < 0.01). All obesity classes had increased associations with hepatorenal syndrome. No significant differences emerged for spontaneous bacterial peritonitis or variceal bleeding. Resource utilization rose with increasing obesity severity, with Class 3 obesity having a 1.84-day longer adjusted length of stay ( < 0.01) and an additional $20 174 in total hospitalization charges ( < 0.01) compared with hospitalizations without obesity.

Conclusions: Class 3 obesity conferred the greatest burden of mortality, complications, and healthcare costs among hospitalizations with AH. Further research is warranted to clarify the intricate interplay between obesity and AH.