The Impact of NAFLD on Hospitalization Outcomes in Patients With Inflammatory Bowel Diseases: Nationwide Analysis

Abstract

Background Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in patients with inflammatory bowel diseases (IBD). Yet, the impact of NAFLD on outcomes, along with the contribution of nonmetabolic factors to NAFLD development, is unclear. To investigate these topics, we conducted a nationwide study examining the impact of NAFLD on hospitalization outcomes in IBD patients after adjusting for metabolic factors. Methods Patients with IBD-related hospitalizations were identified using the Nationwide Readmissions Database from 2016 to 2018. Inflammatory bowel disease patients with and without NAFLD were matched based on IBD type, age, sex, metabolic syndrome, and diabetes mellitus. Primary outcomes were IBD-related readmission, IBD-related surgery, and death. Secondary outcomes were length of stay (LOS) and cost of care (COC). The primary multivariable model adjusted for obesity, dyslipidemia, Charlson-Deyo comorbidity index, hospital characteristics, payer, patient income, and elective status of admissions. Results Nonalcoholic fatty liver disease was associated with a higher risk of IBD-related readmission (adjusted hazard ratio, 1.90; P < .01) and death (adjusted hazard ratio, 2.73; P < .01), 0.71-day longer LOS (P < .01), and $7312 higher COC (P < .01) in those with Crohn’s disease. Nonalcoholic fatty liver disease was also associated with a higher risk of IBD-related readmission (adjusted hazard ratio, 1.65; P < .01), 0.64-day longer LOS (P < .01), and $9392 (P < .01) higher COC, but there was no difference in death in those with UC. No differences in risk of IBD-related surgery were observed. Conclusions Nonalcoholic fatty liver disease is associated with worse hospitalization outcomes in IBD patients after adjusting for metabolic factors. These data suggest nonmetabolic factors may be implicated in the pathogenesis of NAFLD in IBD patients and may contribute to worsened clinical outcomes.

The impact of nonalcoholic fatty liver disease on inflammatory bowel disease-related hospitalization outcomes: a systematic review

“…All 7 articles selected for the analysis included patient cohorts originating from American hospitals. Four studies included only inpatients with administrative data obtained from the Nationwide Readmissions Database [18,19,26] and the Nationwide Inpatient Sample Database (NIS) [25]. Three studies followed patients from initial outpatient settings, with their respective cohorts originating from US-based IBD centers [23,24,27].…”

“…Three studies did not separate patients with CD from those with ulcerative colitis (UC) (n = 1 540 583) [24][25][26]. Only one cohort included and evaluated CD and UC patients separately (n = 18 170 CD and n = 9866 UC patients) [19]. Three articles included only patients with CD (n = 216 206) [18,23,27].…”

“…33 [ 23,27], and an adjusted hazard ratio of 2.5; 95% CI: 1.3-4.9 [23,27], as reported in Table 2. The third study did not report hospitalization rates [18,19,[24][25][26].…”

“…However, few studies have looked at the potential clinical impact of NAFLD on the clinical course of IBD. In fact, NAFLD is the most common cause of abnormal liver function tests in patients with IBD [18,19]. Preliminary reports suggest a link between NAFLD and worsened clinical outcomes in IBD patients, as demonstrated by increased hospitalization and mortality rates, lengths of stay, and costs of care [18,19].…”

Impact of Obesity on the Course of Management of Inflammatory Bowel Disease—A Review

“…The data on the relationship between metabolic syndrome and IBD are somewhat unclear [ 29 ]. Multiple reports indicate a higher prevalence of the coexistence of these disorders, especially concerning UC and metabolic syndrome [ 30 , 31 , 32 ]. Nevertheless, other observations showed a similar presence of a metabolic syndrome in the course of IBD compared to the healthy population.…”