S2849 The Impact of Morbid Obesity on Outcomes and Healthcare Resources Utilization in Patients With Decompensated Liver Cirrhosis

Introduction: Liver cirrhosis relays a significant burden on both individuals and on the healthcare system worldwide. In view of the worldwide epidemic of obesity, the effect of obesity on the outcomes of cirrhosis needs to be evaluated to provide a better understanding of the disease providing effective strategies in the care of this group of patients. Methods: The National Inpatient Sample (NIS) from 2016 to 2020 was retrospectively queried using International Classification of Diseases, Tenth Revision Clinical Modification/PCS codes to identify patients discharged with a diagnosis of decompensated cirrhosis and concomitant morbid obesity defined as a body mass index (BMI) over 40 kg/m². The primary outcome was in-hospital mortality. Secondary outcomes included rate of post-procedural complications such as acute kidney injury (AKI), shock, encephalopathy, and sepsis. Length of stay (LOS), total hospital charges and hospital cost were calculated, and multivariate logistic regression analysis was performed to adjust for potential confounders. Results: We identified a total of 1,006,385 patients that were divided into 2 groups based in the presence of morbid obesity. The group of morbid obesity included 81,324 (8.1%) while the other group included 925,061 (91.9%). Those with morbid obesity were more likely to be women (60.4% vs 47.2%; P < 0.01), White (73.6% vs 67.9%; P < 0.01) and younger (Mean age 60.4 vs 63.5; P < 0.01). On multivariate analysis, patients with morbid obesity had significantly higher in-hospital mortality (aOR 1.18; P < 0.01), and length of stay (aOR 1.88; P < 0.01). Moreover, decompensation events that were higher in patients with morbid obesity were hepatorenal syndrome (aOR 1.28; P < 0.01) and portosystemic encephalopathy (aOR 1.17; P < 0.01). While those without morbid obesity had higher odds of spontaneous bacterial peritonitis (aOR 0.43; P < 0.01), variceal bleeding (aOR 0.77; P < 0.01), variceal bleeding with band ligation (aOR 0.78; P < 0.01), ascites (aOR 0.81; P < 0.01) and portal vein thrombosis (aOR 0.67; P < 0.01). Other in hospital complications that higher odds in patients with morbid obesity included AKI (aOR 1.43; P < 0.01), respiratory failure (aOR 1.33; P < 0.01) and systemic inflammatory response (aOR 1.23; P < 0.01). Conclusion: Morbid obesity was associated with a significantly higher in-hospital mortality in patients with decompensated liver cirrhosis. Also, a specific pattern of decompensation was noticed among these patients.