Burden and Predictors of Non-Alcoholic Fatty Liver Disease in a Retrospective Cohort of Patients With Crohn’s Disease

Abstract

Background Non-alcoholic fatty liver disease (NAFLD) is an emerging extraintestinal manifestation (EIM) of Crohn’s disease (CD). We aimed to investigate the prevalence and comorbid predictors of NAFLD in patients with CD. Methods We conducted a nationwide retrospective cohort study to determine the prevalence, characteristics, comorbidities, and hospitalization outcomes associated with NAFLD in patients with CD. Comparison between groups was performed by Mann-Whitney test for continuous variables and Chi-square test for categorical variables. We performed a binary logistic regression analysis for predictors of NAFLD among patients with CD. Results We extracted 215,049 index hospital discharges with CD; 2.4% had NAFLD. CD patients, with NAFLD, had increased length of stay (4 days; interquartile range (IQR): 2 - 6 vs. 3; IQR: 2 - 6, P < 0.01), and increased median total charges ($32,305.5; IQR: $18,600 - $61,599 vs. $30,782; IQR: $16,847 - $58,667, P < 0.01), compared to CD patients without NAFLD. Non-alcoholic steatohepatitis (NASH) was found to be independently associated with increased mortality (odds ratio (OR): 1.7; 95% confidence interval (CI): 1.1 - 2.6, P = 0.03) and a higher odd for all-cause 30-day non-elective readmission (OR: 1.6: 95% CI: 1.3 - 1.9, P < 0.001). Factors independently associated with NAFLD in patients with CD included portal hypertension (OR: 5.347; 95% CI: 4.604 - 6.211, P < 0.001), vitamin A deficiency (OR: 9.89; 95% CI: 4.49 - 21.76, P < 0.001) and vitamin B12 deficiency (OR: 1.56; 95% CI: 1.098 - 2.209, P = 0.013). Conclusions NAFLD is associated with worse hospitalization outcomes in patients with CD. Study findings suggest the need for early identification and effective management of NAFLD predictors to reduce complications.

The impact of nonalcoholic fatty liver disease on inflammatory bowel disease-related hospitalization outcomes: a systematic review

“…The second study reported an adjusted OR of 259; 95% CI: −787 to 1306, P = 0.627 [25,26]. However, Abomhya et al (215 049 patients) demonstrated an increase in median total hospitalization costs of 32 305.5 USD; IQR = 18 600-61 599 in NAFLD+IBD patients vs. 30 782 USD; IQR = 16 847-58 667, P < 0.001 for those with IBD alone [18]. Noorian et al also showed increased cost of care (COC) in patients with IBD and NAFLD ranging from 7223 to 7634 USD; 95% CI: 923-17 116, P < 0.01 in CD (18 170 patients) and 8358 to 9392 USD; 95% CI: 3200-14 662, P < 0.01 in UC patients (9866 patients) [19].…”

“…33 [ 23,27], and an adjusted hazard ratio of 2.5; 95% CI: 1.3-4.9 [23,27], as reported in Table 2. The third study did not report hospitalization rates [18,19,[24][25][26].…”

“…Only one cohort included and evaluated CD and UC patients separately (n = 18 170 CD and n = 9866 UC patients) [19]. Three articles included only patients with CD (n = 216 206) [18,23,27]. Additional patient characteristics are listed in Table 2.…”

“…Only two inpatient cohorts assessed mortality with one reporting an adjusted OR of 1.7; 95% CI: 1.1-2.6, P < 0.03 in patients with NAFLD+IBD [18,25] as seen in Table 2. However, the adjusted odds of mortality were 0.64; 95% CI: 0.47-0.89, P < 0.009 in NAFLD+IBD patients in the other [25].…”

Prevalence and Impact of Acute Pancreatitis on Hospitalization Outcomes in a Cohort of Patients With Crohn’s Disease

“…This is a retrospective cohort study of patients discharged with a diagnosis of CD between 2016 and 2018. The study was performed in accordance with the 1963 Helsinki Declaration and is exempt from an Institutional Review Board due to the lack of any identifying patient information [17,18].…”