Malnutrition Linked to Several Adverse Alcoholic Hepatitis Outcomes

David U. Lee, MD

While malnutrition is common for patients with alcoholic hepatitis, it might impact different patients and influence outcomes differently.

A team, led by David U. Lee, MD, Liver Center, Division of Gastroenterology, Tufts Medical Center, evaluated the effect of malnutrition on the infection risks of patients admitted to the hospital with alcoholic hepatitis.

In the study, the researchers used a 2011-2017 National Inpatient Sample to isolate patients with alcoholic hepatitis and stratified the sample using malnutrition—protein-calorie malnutrition, sarcopenia, and weight loss/cachexia.

They then matched each patient using age, gender, and race with 1:1 nearest neighbor match method.

The investigators sought endpoints including mortality and infectious endpoints.

The Cohort

Overall, there were 10,520 patients included in the analysis with malnutrition, as well as 10,520 individuals with malnutrition in the control arm.

The researchers found higher mortality rates in the malnutrition cohort (5.02 vs. 2.29%; P <0.001, OR, 2.25; 95% CI, 1.93-2.63). This was also true for sepsis (14.2 vs. 5.46%; P <0.001; OR, 2.87; 95% CI, 2.60-3.18), pneumonia (10.9 vs. 4.63%; P <0.001; OR, 2.51; 95% CI, 2.25-2.81), and urinary tract infection (14.8 vs. 9.01%; P <0.001; OR, 1.76; 95% CI, 1.61-1.91).

These trends for the malnutrition group were also found for cellulitis (3.17 vs. 2.18%; P <0.001; OR, 1.47; 95% CI, 1.24-1.74), cholangitis (0.52 vs. 0.20%; P <0.001; OR, 2.63; 95% CI, 1.59-4.35), and Clostridium difficile infection (CDI) (1.67 vs. 0.91%; P <0.001; OR, 1.85; 95% CI, 1.44-2.37).

Multivariable Models

The researchers then used multivariate models and found malnutrition was linked to mortality (P <0.001; aOR, 1.61; 95% CI, 1.37-1.90)

Malnutrition was also linked to various infectious endpoints, including sepsis (P <0.001; aOR, 2.42; 95% CI, 2.18-2.69), pneumonia (P<0.001, aOR, 2.19; 95% CI; 1.96-2.46), urinary tract infection (P <0.001; aOR, 1.68; 95% CI, 1.53-1.84), cellulitis (P <0.001; aOR, 1.46; 95% CI, 1.22-1.74), cholangitis (P = 0.002; aOR, 2.27, 95% CI, 1.36-3.80), and C. difficile infection (P <0.001; aOR, 1.89; 95% CI, 1.46-2.44).

“This study shows the presence of malnutrition is an independent risk factor of mortality and local/systemic infections in patients admitted with alcoholic hepatitis,” the authors wrote.

Role of Alcohol

Last year researchers discovered that more research is needed to explore the role of alcohol in the pathogenesis of hepatitis B viral (HBV) infections.

HBV and alcohol abuse often contribute to the development of end-stage liver disease, where the alcohol abuse can cause a rapid progression of liver disease in HBV infected patients. This also allows the HBV to persist chronically.

However, the mechanism by which alcohol promotes the progression of HBV-associated liver disease is not completely understood.

Some of the potential mechanisms for this interaction include a suppressed immune response, oxidative stress, endoplasmic reticulum and Golgi apparatus stresses, and increased HBV replication.

Chronic alcohol intake alters the architecture and compromises the functional capacity of the liver, where alcohol metabolism is catalyzed by alcohol dehydrogenase and cytochrome P450 2E1 (CYP2E1) to acetaldehyde and this major metabolite is the culprit for the majority of the toxic effects associated with alcohol use.

The study, “The Impact of Malnutrition on the Hospital and Infectious Outcomes of Patients Admitted With Alcoholic Hepatitis,” was published online in Clinical Gastroenterology.