III类肥胖是失代偿期肝硬化患者发生急性慢性肝衰竭的危险

StephenW

Class III obesity is a risk factor for the development of acute-on-chronic liver failure in patients with decompensated cirrhosis
Vinay Sundaram'Correspondence information about the author Vinay SundaramEmail the author Vinay Sundaram
, Rajiv Jalan
, Joseph C. Ahn
, Michael R. Charlton
, David S. Goldberg
, Constantine J. Karvellas
, Mazen Noureddin
, Robert J. Wong
PlumX Metrics
DOI: https://doi.org/10.1016/j.jhep.2018.04.016 |
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Highlights

    •Class III obesity is an independent risk factor for acute-on-chronic liver failure.
    •Renal failure was increasingly prevalent with worsening obesity category.
    •Management of obese cirrhotic patients should emphasize weight loss and careful use of diuretics and nephrotoxic medications.

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.
Keywords:
Inflammation, Portal hypertension, Organ failure, Renal failure, CLIF-SOFA

StephenW

III类肥胖是失代偿期肝硬化患者发生急性慢性肝衰竭的危险因素
Vinay Sundaram'Correspondence有关作者Vinay Sundaram的信息，以及作者Vinay Sundaram
，Rajiv Jalan
，Joseph C. Ahn
，Michael R. Charlton
，David S. Goldberg
，康斯坦丁J.卡维拉斯
，Mazen Noureddin
，Robert J. Wong
PlumX度量标准
DOI：https：//doi.org/10.1016/j.jhep.2018.04.016 |
showArticle信息

  
强调

    •III类肥胖是急性慢性肝衰竭的独立危险因素。
    •随着肥胖类别的恶化，肾功能衰竭越来越普遍。
    •肥胖肝硬化患者的管理应强调减肥和小心使用利尿剂和肾毒性药物。

背景与目的

急性慢性肝衰竭（ACLF）是全身炎症和器官衰竭的综合征。肥胖也以慢性炎症为特征，是肝硬化失代偿，感染和死亡的患者的危险因素。我们的目的是检验肥胖使患有失代偿性肝硬化的患者易患ACLF的假设。
方法

我们检查了2005 - 2016年的联合网络器官共享（UNOS）数据库，将等待列为非肥胖的患者（体重指数[BMI] <30），肥胖I-II级（BMI 30-39.9）进行了检查。和肥胖III级（BMI≥40）。 ACLF是根据CANONIC研究定义确定的。我们使用Cox比例风险回归来评估肥胖与肝移植（LT）的ACLF发展之间的关联。我们使用全国住院患者样本（NIS）（2009 - 2013年）确认了我们的研究结果，使用经过验证的诊断编码算法来识别肥胖，肝功能失代偿和ACLF。 Logistic回归评估了肥胖与ACLF发生之间的关联。
结果

在387,884例失代偿期肝硬化患者中，116,704例（30.1％）在两个数据库中被确定为患有ACLF。来自UNOS数据库的多变量建模显示，III类肥胖是LT患ACLF的独立危险因素（风险比1.24; 95％CI 1.09-1.41; p <0.001）。使用NIS证实了这一发现（比值比1.30; 95％CI 1.25-1.35; p <0.001）。关于特定器官衰竭，对两个登记处的分析表明，I-II级和III级肥胖患者的肾衰竭患病率更高。
结论

III级肥胖是失代偿性肝硬化患者ACLF发展的新发现风险因素。作为ACLF的一个组成部分，肥胖患者肾功能衰竭的患病率特别高。这些发现对于分层风险和预防ACLF的发生具有重要意义。
放置摘要

在本研究中，我们发现在失代偿期肝硬化患者中，III级肥胖（严重/病态肥胖）是急性慢性肝衰竭（ACLF）发展的可改变的危险因素。我们进一步证明，对于与ACLF相关的特定器官衰竭，肾衰竭在肥胖患者中显着更普遍，特别是那些患有III类肥胖的患者。这些发现强调了肝硬化体重管理的重要性，以降低ACLF的风险。应密切监测III级肥胖患者的肾功能衰竭的发展。
关键词：
炎症，门脉高压，器官衰竭，肾功能衰竭，CLIF-SOFA