Clinical Outcomes in Acute Decompensated Metabolic Dysfunction-associated Steatotic Liver Disease Cirrhosis: The Role of BMI in Mortality, Readmission, and Hospital Stay

Division

South Atlantic

Hospital

Grand Strand Medical Center

Document Type

Manuscript

Publication Date

7-7-2025

Keywords

BMI, Body mass index, mortality, readmission, hospital stay, acute decompensated non-alcoholic fatty liver cirrhosis, metabolic dysfunction-associated steatotic liver disease

Disciplines

Digestive System Diseases | Health and Medical Administration | Internal Medicine | Medicine and Health Sciences

Abstract

BACKGROUND: This study examines the impact of Body Mass Index (BMI) on mortality, readmission rates, and hospital stay lengths in patients with acute decompensated non-alcoholic fatty liver cirrhosis, now termed metabolic dysfunction-associated steatotic liver disease (MASLD).

OBJECTIVE: To assess the relationship between BMI and outcomes such as mortality, readmission rates, and hospital and ICU lengths of stay in patients with acute decompensated MASLD.

DESIGN: Retrospective cohort analysis.

PARTICIPANTS: Conducted at Grand Strand Medical Center, Myrtle Beach, SC, this study included 43,942 patients, using data from the Hospital Corporation of America Enterprise Data Warehouse from 2017-2022.

MAIN MEASURES: Logistic regression and negative binomial models were used, adjusting for age, gender, race, diabetes, and hyperlipidemia.

KEY RESULTS: A notable "obesity paradox" was observed: underweight patients had over twice the odds of mortality (OR = 2.12, 95% CI: 1.83-2.46; p <  0.0001) compared to healthy-weight patients, suggesting a protective effect of higher BMI. While BMI did not significantly affect overall readmission, patients with Class III obesity had lower readmission odds (OR = 0.86, 95% CI: 0.77-0.96; p = 0.0012). However, Class III obesity was linked to increased hospital (IRR = 1.20, 95% CI: 1.15-1.26; p <  0.0001) and ICU LOS (IRR = 1.12, 95% CI: 1.04-1.20; p <  0.0001). Diabetes (IRR = 1.09, 95% CI: 1.06-1.11) and hyperlipidemia (IRR = 1.34, 95% CI: 1.31-1.38) were also associated with longer LOS (p <  0.0001).

CONCLUSION: These findings highlight the complexity of BMI's role in MASLD outcomes. The observed obesity paradox warrants further investigation to inform care strategies across BMI categories.

Publisher or Conference

Journal of General Internal Medicine

Link to Full Text

Share

COinS