背景:代谢功能障碍相关的脂肪变性肝病(MASLD)与心血管(CV)风险增加有关,尤其是充血性心力衰竭(CHF)。我们评估了MASLD对住院肝硬化患者CHF和死亡率的影响。
方法:我们分析了2016年至2020年的全国住院患者样本,确定了成年肝硬化患者。我们专注于CHF和住院死亡率,加上住院时间,成本,和出院状态。倾向得分匹配创建了用于比较的平衡队列。泊松和逻辑回归为MASLD患者提供调整后的CHF风险和死亡率比值比(ORs)。
结果:在匹配之前,672,625例肝硬化患者中有4.1%患有MASLD。匹配后,每组有23,161例患者.MASLD患者的CHF风险较高(OR1.14,95%CI1.10-1.21,p<0.001),但住院死亡率较低(OR0.57,95%CI0.52-0.63,p<0.01),费用降低(中位数24,447美元vs.$28,630,OR0.86,95%CI0.85-0.87,p<0.001)。
结论:在这项全国性的肝硬化患者研究中,MASLD与较高的CHF患病率和较低的住院死亡率相关。这些发现反映了“肥胖悖论”现象,与体重正常的人相比,患有心脏代谢功能障碍的肥胖/超重个体的健康结局可能较不严重或有益.需要进一步的调查来解码MASLD之间复杂的相互作用,肝硬化,CHF,以及院内死亡率及其对临床实践的影响。
BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is linked to increased cardiovascular (CV) risks, notably congestive heart failure (CHF). We evaluated the influence of MASLD on CHF and mortality among hospitalized cirrhotic patients.
METHODS: We analyzed the National Inpatient Sample from 2016 to 2020, identifying adult cirrhosis patients. We focused on CHF and in-hospital mortality, plus hospital stay length, costs, and discharge status. Propensity score matching created balanced cohorts for comparison. Poisson and logistic regression provided adjusted CHF risks and mortality odds ratios (ORs) for MASLD patients.
RESULTS: Before matching, 4.1% of 672,625 cirrhotic patients had MASLD. Post-matching, each group had 23,161 patients. Patients with MASLD showed higher CHF risk (OR 1.14, 95% CI 1.10-1.21, p<0.001) but lower in-hospital mortality (OR 0.57, 95% CI 0.52-0.63, p<0.01) and decreased costs (median $24,447 vs. $28,630, OR 0.86, 95% CI 0.85-0.87, p<0.001).
CONCLUSIONS: In this nationwide study of patients with cirrhosis, MASLD was associated with a higher prevalence of CHF and lower in-patient mortality. These findings mirror the \"adiposity paradox\" phenomenon, where obese/overweight individuals with cardiometabolic dysfunction may experience less severe or beneficial health outcomes than those with a normal weight. Further investigation is warranted to decode the intricate interplay between MASLD, cirrhosis, CHF, and in-hospital mortality and its clinical practice implications.