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

Abstract

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). 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. Retrospective cohort analysis. 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. Logistic regression and negative binomial models were used, adjusting for age, gender, race, diabetes, and hyperlipidemia. 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). 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.