Burden of Non-Alcoholic Fatty Liver Disease Among Patients With Crohn’s Disease: Analysis of the Nationwide Readmission Database

Abstract

INTRODUCTION Non-alcoholic fatty liver disease (NAFLD) is a spectrum that ranges from hepatic steatosis to Non-alcoholic steatohepatitis (NASH). NASH can lead to liver fibrosis, cirrhosis, and hepatocellular carcinoma. (Chao CY et al. World J Gastroenterol). Both NAFLD and Crohn’s disease are associated with increased gut permeability. (Miele L et al Hepatology, Pearson AD et al. Br Med J). Current evidence has shown fatty liver disease to be the most common explanation for abnormal liver tests in patients with IBD. (Gisbert JP et al. Inflamm Bowel Dis). A practical approach may be pursued in identifying patients with IBD at risk for having NAFLD and subsequently identifying patients at an increased risk of morbidity and mortality. METHODS We collected data from the publicly available Healthcare Cost and Utilization Project (HCUP) Nationwide Readmission Databases (NRD) 2016, 2017, and 2018. We identified and analyzed the burden of NAFLD amongst individuals discharged with a diagnosis of CD or one of its complications (Figure 1). We studied the characteristics, co-morbidities, and hospitalization outcomes of CD patients with NAFLD. A subgroup analysis was performed for those with NASH. Patients who died in index hospitalization or were discharged in Dec. were excluded from the 30-day readmission analysis. Median and IQR were used to describe Continuous variables, and proportions were used with categorical variables. Comparison between groups was performed by Mann Whitney test for continuous variables and Chi-Square test for Categorical variables. We performed a binary logistic regression analysis for predictors of NAFLD among patients with CD. Statistical analyses were performed using SPSS Version 25 (IBM Corporation, Armonk, NY, USA). RESULTS We analyzed 215,049 index hospital discharges with Crohn’s disease or one of its complications. 2.4% had NAFLD. Hypertension, diabetes, Dyslipidemia, Obesity, and metabolic syndrome are the five most recognized risk factors for NAFLD in the general population. 35.9% of CD patients with NAFLD had none of those risk factors (Table 1). 0.42 % of CD patients had a diagnosis of NASH. Subgroup analysis for CD patients with NASH showed increased mortality, increased length of stay, and a higher rate of 30-day readmission among CD patients with NASH (Table 2). Predictors of NAFLD in patients with CD are illustrated in Table 3. The chi-square test results indicate that our regression model is a significant improvement in fit relative to an intercept-only model (χ2 = 1593.171, p<.001). CONCLUSION The presence of NAFLD in patients with CD is associated with metabolic syndrome components and CD-specific risk factors. The development of NASH is associated with increased morbidity and mortality in patients with CD. Further studies are needed to investigate the pathogenesis of NAFLD in CD patients.