S2609 Impact of Obesity on Mortality and Clinical Outcomes in Patients With Alcoholic Hepatitis: A Retrospective Matched Cohort Analysis

Introduction: Alcoholic hepatitis (AH) is a severe form of alcohol-related liver disease associated with high short- and long-term mortality. Despite obesity being a prevalent and rising global comorbidity, its impact on AH remains poorly explored. This retrospective cohort study examines the relationship between obesity and clinical outcomes in patients with AH, providing insights into how this prevalent comorbidity affects mortality. Methods: Using the TriNetX network of electronic health records from 97 global healthcare organizations, we identified patients aged 18–100 diagnosed with AH. Cohorts were stratified by body mass index (BMI ≥30 kg/m² for obese and <30 kg/m² for non-obese), identified via International Classification of Diseases, Tenth Revision codes. Before matching, the obese cohort included 19,592 patients and the non-obese cohort 37,458. Mean age and demographics were similar (48.2 ± 12.4 vs 47.7 ± 13 years, predominantly White men). 1:1 propensity score matching was performed for age, sex, race/ethnicity, hypertension, hyperlipidemia, diabetes mellitus, ischemic heart disease, chronic kidney disease, nicotine use, and corticosteroid use. Patients with a history of liver cell carcinoma, hepatitis B and C, cirrhosis of any etiology, acute and subacute liver failure, liver transplantation, autoimmune hepatitis, Metabolic Dysfunction-Associated Steatotic Liver Disease, and pregnancy were excluded. The primary outcome was all-cause mortality at 30, 90, and 365 days. Secondary outcomes included acute renal failure (ARF), hepatic encephalopathy (HE), spontaneous bacterial peritonitis (SBP), ARDS, mechanical ventilation, and liver transplant at 1 year. Patients with outcomes documented prior to AH diagnosis were excluded. Results: After matching, each cohort included 19,421 patients. Obesity was associated with increased mortality at all timepoints and higher rates of all secondary outcomes. Conclusion: These findings suggest that obesity independently contributes to worse clinical outcomes in patients with AH. Prospective studies are mandatory to validate these findings and optimize management strategies for obese patients with AH.