Ezeani Chukwunonso, Omaliko Chidiebele, Al-Ajlouni Yazan A, Njei Basile
Department of Internal Medicine, Baton Rouge General Medical Center, Baton Rouge, USA.
Department of Internal Medicine, Brookdale University Hospital and Medical Center, New York, USA.
Cureus. 2024 May 24;16(5):e60968. doi: 10.7759/cureus.60968. eCollection 2024 May.
Metabolic dysfunction-associated steatohepatitis (MASH) is an important cause of cirrhosis and end-stage liver disease. In addition, there have been reports of worse extrahepatic outcomes, especially cardiovascular events, in patients with lean patients' fatty liver disease compared to the non-lean group. There is limited data on hepatic, cardiac, and renal outcomes in lean compared to non-lean patients with MASH. This study aims to evaluate the cardiovascular, renal, and hepatic outcomes in hospitalized US adults with MASH, focusing on a comprehensive comparison between lean and non-lean patients.
The National Inpatient Sample (NIS) database was queried from 2016 to 2020 to identify hospitalizations with MASH. Hospitalizations with a history of overweight and obesity (lean body mass index (BMI) <25 vs. lean BMI >25) were also identified. The primary outcome was in-hospital mortality. Secondary outcomes were major adverse cardiovascular outcomes (MACE: a composite of acute myocardial infarction, cardiac arrest, stroke, heart failure, and atrial fibrillation); major adverse kidney outcome (MAKE: a composite outcome of acute kidney injury (AKI), renal replacement therapy, and renal cancer), and hepatic decompensation (esophageal varices with bleeding, ascites, spontaneous bacterial peritonitis (SBP), hepatic encephalopathy, and hepatorenal syndrome) Multivariate logistic regression analysis was used to derive risk ratios for clinical outcomes.
We included 539,275 MASH patients in our sample; 324,330 (60%) were lean. The included patients were mostly female (61%), the mean age was 64 years, and 76% were White. At baseline, non-lean patients had a higher prevalence of heart failure, hypertension, and hyperlipidemia. There was no difference in the prevalence of smoking among both groups. In a multivariate analysis, with adjustment for age, sex, race, sarcopenia, cardiometabolic risk factors, hospital characteristics, admission type, socioeconomic factors, and all comorbidities (including 31 Elixhauser comorbidities), lean status was associated with a 40% increased risk of mortality (adjusted odds ratio (aOR) 1.40, confidence interval (CI) 1.29-1.53), 19% increased risk of MACE (aOR 1.19; 95% CI 1.14-1.24), 20% increased risk of renal decompensation (aOR 1.25; 95% CI 1.20-1.30), and 33% increased risk of hepatic decompensation (aOR 1.33 CI 1.28-1.38).
Lean patients with MASH are at higher risk of cardiovascular and renal outcomes and may benefit from enhanced screening for early identification and treatment to improve outcomes.
代谢功能障碍相关脂肪性肝炎（MASH）是肝硬化和终末期肝病的重要病因。此外，有报道称，与非肥胖组相比，肥胖的脂肪肝患者有更差的肝外结局，尤其是心血管事件。与非肥胖的MASH患者相比，肥胖患者肝脏、心脏和肾脏结局的数据有限。本研究旨在评估美国住院的MASH成年患者的心血管、肾脏和肝脏结局，重点是肥胖和非肥胖患者之间的全面比较。
查询2016年至2020年的全国住院患者样本（NIS）数据库，以确定MASH住院患者。还确定了有超重和肥胖病史的住院患者（瘦体重指数（BMI）<25与瘦BMI>25）。主要结局是住院死亡率。次要结局是主要不良心血管结局（MACE：急性心肌梗死、心脏骤停、中风、心力衰竭和房颤的综合）；主要不良肾脏结局（MAKE：急性肾损伤（AKI）、肾脏替代治疗和肾癌的综合结局），以及肝失代偿（食管静脉曲张出血、腹水、自发性细菌性腹膜炎（SBP）、肝性脑病和肝肾综合征）。采用多因素逻辑回归分析得出临床结局的风险比。
我们的样本包括539275例MASH患者；324330例（60%）为肥胖患者。纳入的患者大多为女性（61%），平均年龄为64岁，76%为白人。基线时，非肥胖患者心力衰竭、高血压和高脂血症的患病率较高。两组吸烟患病率无差异。在多因素分析中，调整年龄、性别、种族、肌肉减少症、心脏代谢危险因素、医院特征、入院类型、社会经济因素和所有合并症（包括31种艾利克斯豪泽合并症）后，肥胖状态与死亡风险增加40%相关（调整优势比（aOR）1.40，置信区间（CI）1.29-1.53），MACE风险增加19%（aOR 1.19；95%CI 1.14-1.24），肾脏失代偿风险增加20%（aOR 1.25；95%CI 1.20-1.30），肝失代偿风险增加33%（aOR 1.33 CI 1.28-1.38）。
肥胖的MASH患者发生心血管和肾脏结局的风险更高，可能受益于加强筛查以早期识别和治疗，从而改善结局。
