NAFLD Increases Odds of Severe Outcomes for IBD Patients

Shaya Noorian, MD

Inflammatory bowel disease (IBD) patients with non-alcoholic fatty liver disease (NAFLD) are at an increased risk of a number of negative outcomes when compared to IBD patients without NALFD.

A team, led by Shaya Noorian, MD, UCLA David Geffen School of Medicine, identified the impact of NAFLD on hospitalization outcomes in IBD patients after adjusting for metabolic factors as part of a nationwide study.

NAFLD is a common comorbidity for patients with IBD. However, the impact of the liver disease on outcomes and the contribution of nonmetabolic factors to NAFLD development is not yet known.

The Study

In the study, the investigators identified patients with IBD-related hospitalizations using the Nationwide Readmissions Database between 2016-2018. They then matched the patients as those with and without NAFLD based on IBD type, age, sex, metabolic syndrome, and diabetes mellitus.

The investigators sought primary outcomes of IBD-related readmission, IBD-related surgery, and death. They also sought various secondary outcomes, including length of stay, and cost of care.

The team also used a primary multivariable model that was adjusted for obesity, dyslipidemia, Charlson-Deyo comorbidity index, hospital characteristics, payer, patient income, and elective status of admissions.

The Risk

Overall, NAFLD was linked to a higher risk of IBD-related readmission (aHR, 1.90;P <.01), as well as death (aHR, 2.73; P <.01) for Crohn’s disease patients.There was also a 0.71-day longer length of stay (P <.01) and $7,312 higher cost of care (P <.01) for this patient population.

For ulcerative colitis patients with NAFLD, there was also a higher risk of IBD-related readmission (aHR, 1.65; P <.01), 0.64-day longer length of stay (P <.01) and $9,392 (P <.01) higher cost of care.

However, there was no difference observed in deaths for patients with ulcerative colitis.

There was also no differences in risk of IBD-related surgery observed for patients with either Crohn’s disease or ulcerative colitis.

“Nonalcoholic fatty liver disease is associated with worse hospitalization outcomes in IBD patients after adjusting for metabolic factors,” the authors wrote. “These data suggest nonmetabolic factors may be implicated in the pathogenesis of NAFLD in IBD patients and may contribute to worsened clinical outcomes.”

NAFLD and CKD

Patients being treated for chronic kidney disease (CKD) had a high frequency of NAFLD.

Earlier this year, investigators from Egypt conducted a cross-sectional study including 80 patients with non-diabetic CKD in order to evaluate the frequency of NAFLD in these types of patients.

Just over half of the patients (56%) were found to have NAFLD. Of the 30 males and 15 females with NAFLD, there were 29 patients with end-stage renal disease who were on regular hemodialysis and an additional 16 patients with pre-dialysis CKD G3-5.

The investigators concluded that the mean CAP values of hepatic steatosis in the patients with CKD on dialysis and the patients with pre-dialysis CKD were 265 and 259, respectively. In addition, there was a significant association between the severity of hepatic steatosis degree with decreased glomerular filtration rate, as well as with increased CKD stage.

The degree of liver stiffness was significantly related to an increased hepatis steatosis grade. There was a significant positive correlation between the degree of NAFLD and serum levels of alanine aminotransferase, aspartate transaminase, total cholesterol, triglycerides, low-density lipoprotein, and CRP titer.

NAFLD was significantly associated with a history of cardiovascular disease among the study group.

The study, “The Impact of NAFLD on Hospitalization Outcomes in Patients With Inflammatory Bowel Diseases: Nationwide Analysis,” was published online in Inflammatory Bowel Diseases.