PMID- 29709681
OWN - NLM
STAT- In-Data-Review
LR  - 20180819
IS  - 1600-0641 (Electronic)
IS  - 0168-8278 (Linking)
VI  - 69
IP  - 3
DP  - 2018 Sep
TI  - Class III obesity is a risk factor for the development of acute-on-chronic liver 
      failure in patients with decompensated cirrhosis.
PG  - 617-625
LID - S0168-8278(18)32027-0 [pii]
LID - 10.1016/j.jhep.2018.04.016 [doi]
AB  - BACKGROUND & AIMS: Acute-on-chronic liver failure (ACLF) is a syndrome of
      systemic inflammation and organ failures. Obesity, also characterized by chronic 
      inflammation, is a risk factor among patients with cirrhosis for decompensation, 
      infection, and mortality. Our aim was to test the hypothesis that obesity
      predisposes patients with decompensated cirrhosis to the development of ACLF.
      METHODS: We examined the United Network for Organ Sharing (UNOS) database, from
      2005-2016, characterizing patients at wait-listing as non-obese (body mass index 
      [BMI] <30), obese class I-II (BMI 30-39.9) and obese class III (BMI >/=40). ACLF 
      was determined based on the CANONIC study definition. We used Cox proportional
      hazards regression to assess the association between obesity and ACLF development
      at liver transplantation (LT). We confirmed our findings using the Nationwide
      Inpatient Sample (NIS), years 2009-2013, using validated diagnostic coding
      algorithms to identify obesity, hepatic decompensation and ACLF. Logistic
      regression evaluated the association between obesity and ACLF occurrence.
      RESULTS: Among 387,884 patient records of decompensated cirrhosis, 116,704
      (30.1%) were identified as having ACLF in both databases. Multivariable modeling 
      from the UNOS database revealed class III obesity to be an independent risk
      factor for ACLF at LT (hazard ratio 1.24; 95% CI 1.09-1.41; p<0.001). This
      finding was confirmed using the NIS (odds ratio 1.30; 95% CI 1.25-1.35; p<0.001).
      Regarding specific organ failures, analysis of both registries demonstrated
      patients with class I-II and class III obesity had a greater prevalence of renal 
      failure. CONCLUSION: Class III obesity is a newly identified risk factor for ACLF
      development in patients with decompensated cirrhosis. Obese patients have a
      particularly high prevalence of renal failure as a component of ACLF. These
      findings have important implications regarding stratifying risk and preventing
      the occurrence of ACLF. LAY SUMMARY: In this study, we identify that among
      patients with decompensated cirrhosis, class III obesity (severe/morbid obesity) 
      is a modifiable risk factor for the development of acute-on-chronic liver failure
      (ACLF). We further demonstrate that regarding the specific organ failures
      associated with ACLF, renal failure is significantly more prevalent in obese
      patients, particularly those with class III obesity. These findings underscore
      the importance of weight management in cirrhosis, to reduce the risk of ACLF.
      Patients with class III obesity should be monitored closely for the development
      of renal failure.
CI  - Copyright (c) 2018 European Association for the Study of the Liver. Published by 
      Elsevier B.V. All rights reserved.
FAU - Sundaram, Vinay
AU  - Sundaram V
AD  - Division of Gastroenterology and Comprehensive Transplant Center, Cedars-Sinai
      Medical Center, Los Angeles, CA, United States. Electronic address:
      Vinay.Sundaram@cshs.org.
FAU - Jalan, Rajiv
AU  - Jalan R
AD  - Liver Failure Group, Institute for Liver and Digestive Health, UCL Medical
      School, London, UK.
FAU - Ahn, Joseph C
AU  - Ahn JC
AD  - Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United
      States.
FAU - Charlton, Michael R
AU  - Charlton MR
AD  - University of Chicago School of Medicine, Chicago, IL, United States.
FAU - Goldberg, David S
AU  - Goldberg DS
AD  - Department of Medicine and Department of Epidemiology, University of
      Pennsylvania, Philadelphia, PA, United States.
FAU - Karvellas, Constantine J
AU  - Karvellas CJ
AD  - Division of Gastroenterology and Department of Critical Care Medicine, University
      of Alberta, Edmonton, Canada.
FAU - Noureddin, Mazen
AU  - Noureddin M
AD  - Division of Gastroenterology and Comprehensive Transplant Center, Cedars-Sinai
      Medical Center, Los Angeles, CA, United States.
FAU - Wong, Robert J
AU  - Wong RJ
AD  - Division of Gastroenterology and Hepatology, Alameda Health System, Highland
      Hospital, Oakland, CA, United States.
LA  - eng
PT  - Journal Article
DEP - 20180428
PL  - Netherlands
TA  - J Hepatol
JT  - Journal of hepatology
JID - 8503886
OTO - NOTNLM
OT  - CLIF-SOFA
OT  - Inflammation
OT  - Organ failure
OT  - Portal hypertension
OT  - Renal failure
EDAT- 2018/05/02 06:00
MHDA- 2018/05/02 06:00
CRDT- 2018/05/01 06:00
PHST- 2018/01/14 00:00 [received]
PHST- 2018/03/10 00:00 [revised]
PHST- 2018/04/15 00:00 [accepted]
PHST- 2018/05/02 06:00 [pubmed]
PHST- 2018/05/02 06:00 [medline]
PHST- 2018/05/01 06:00 [entrez]
AID - S0168-8278(18)32027-0 [pii]
AID - 10.1016/j.jhep.2018.04.016 [doi]
PST - ppublish
SO  - J Hepatol. 2018 Sep;69(3):617-625. doi: 10.1016/j.jhep.2018.04.016. Epub 2018 Apr
      28.