背景:代谢功能障碍相关脂肪性肝炎(MASH)是肝硬化和终末期肝病的重要原因。此外,有报告说肝外结果更差,尤其是心血管事件,与非瘦肉组相比,瘦肉组的脂肪肝患者。关于肝脏的数据有限,心脏,与使用MASH的非瘦患者相比,瘦患者的肾脏结局。本研究旨在评估心血管疾病,肾,和MASH住院的美国成年人的肝脏结局,专注于瘦和非瘦患者之间的全面比较。
方法:从2016年至2020年查询了国家住院患者样本(NIS)数据库,以确定使用MASH的住院情况。有超重和肥胖病史的住院治疗(瘦体重指数(BMI)<25vs.瘦体重指数>25)也被确定。主要结果是院内死亡率。次要结局是主要的不良心血管结局(MACE:急性心肌梗死的复合,心脏骤停,中风,心力衰竭,和心房颤动);主要不良肾脏结局(MAKE:急性肾损伤(AKI)的复合结局,肾脏替代疗法,和肾癌),和肝功能失代偿(食管静脉曲张伴出血,腹水,自发性细菌性腹膜炎(SBP),肝性脑病,和肝肾综合征)使用多因素logistic回归分析得出临床结局的风险比。
结果:我们在我们的样本中包括539,275名MASH患者;324,330名(60%)是瘦的。纳入的患者大多为女性(61%),平均年龄是64岁,76%是白人。在基线,非瘦患者的心力衰竭患病率较高,高血压,和高脂血症。两组的吸烟率没有差异。在多变量分析中,随着年龄的调整,性别,种族,少肌症,心脏代谢危险因素,医院特色,入学类型,社会经济因素,和所有合并症(包括31种Elixhauser合并症),瘦状态与死亡风险增加40%相关(调整比值比(AOR)1.40,置信区间(CI)1.29-1.53),MACE风险增加19%(aOR1.19;95%CI1.14-1.24),肾功能失代偿风险增加20%(aOR1.25;95%CI1.20-1.30),肝失代偿风险增加33%(aOR1.33CI1.28-1.38)。
结论:MASH患者的心血管和肾脏结局的风险更高,并且可能受益于早期识别和治疗以改善结局的增强筛查。
BACKGROUND: Metabolic dysfunction-associated steatohepatitis (
MASH) is an important cause of cirrhosis and end-stage liver disease. In addition, there have been reports of worse extrahepatic outcomes, especially cardiovascular events, in patients with lean patients\' fatty liver disease compared to the non-lean group. There is limited data on hepatic, cardiac, and renal outcomes in lean compared to non-lean patients with
MASH. This study aims to evaluate the cardiovascular, renal, and hepatic outcomes in hospitalized US adults with
MASH, focusing on a comprehensive comparison between lean and non-lean patients.
METHODS: The National Inpatient Sample (NIS) database was queried from 2016 to 2020 to identify hospitalizations with MASH. Hospitalizations with a history of overweight and obesity (lean body mass index (BMI) <25 vs. lean BMI >25) were also identified. The primary outcome was in-hospital mortality. Secondary outcomes were major adverse cardiovascular outcomes (MACE: a composite of acute myocardial infarction, cardiac arrest, stroke, heart failure, and atrial fibrillation); major adverse kidney outcome (MAKE: a composite outcome of acute kidney injury (AKI), renal replacement therapy, and renal cancer), and hepatic decompensation (esophageal varices with bleeding, ascites, spontaneous bacterial peritonitis (SBP), hepatic encephalopathy, and hepatorenal syndrome) Multivariate logistic regression analysis was used to derive risk ratios for clinical outcomes.
RESULTS: We included 539,275
MASH patients in our sample; 324,330 (60%) were lean. The included patients were mostly female (61%), the mean age was 64 years, and 76% were White. At baseline, non-lean patients had a higher prevalence of heart failure, hypertension, and hyperlipidemia. There was no difference in the prevalence of smoking among both groups. In a multivariate analysis, with adjustment for age, sex, race, sarcopenia, cardiometabolic risk factors, hospital characteristics, admission type, socioeconomic factors, and all comorbidities (including 31 Elixhauser comorbidities), lean status was associated with a 40% increased risk of mortality (adjusted odds ratio (aOR) 1.40, confidence interval (CI) 1.29-1.53), 19% increased risk of MACE (aOR 1.19; 95% CI 1.14-1.24), 20% increased risk of renal decompensation (aOR 1.25; 95% CI 1.20-1.30), and 33% increased risk of hepatic decompensation (aOR 1.33 CI 1.28-1.38).
CONCLUSIONS: Lean patients with
MASH are at higher risk of cardiovascular and renal outcomes and may benefit from enhanced screening for early identification and treatment to improve outcomes.