Obesity is independently associated with infection in hospitalised patients with end-stage liver disease.
BACKGROUND
Infection is the most common cause of mortality in end-stage liver disease (ESLD). The impact of obesity on infection risk in ESLD is not established.


OBJECTIVE
To characterise the impact of obesity on infection risk in ESLD.


METHODS
We evaluated the association between infection and obesity in patients with ESLD. Patients grouped as non-obese, obesity class I-II and obesity class III were studied using the Nationwide Inpatient Sample. Validated diagnostic code based algorithms were utilised to determine weight category and infections, including bacteraemia, skin/soft tissue infection, urinary tract infection (UTI), pneumonia/respiratory infection, Clostridium difficile infection (CDI) and spontaneous bacterial peritonitis (SBP). Risk factors for infection and mortality were assessed using multivariable logistic regression analysis.


RESULTS
Of 115 465 patients identified, 100 957 (87.5%) were non-obese and 14 508 (12.5%) were obese, with 9489 (8.2%) as obesity class I-II and 5019 (4.3%) as obesity class III. 37 117 patients (32.1%) had an infection diagnosis. Infection was most prevalent among obesity class III (44.0%), followed by obesity class I-II (38.9%) and then non-obese (31.9%). In multivariable modelling, class III obesity (OR = 1.41; 95% CI 1.32-1.51; P < 0.001), and class I-II obesity (OR = 1.08; 95% CI 1.01-1.15; P = 0.026) were associated with infection. Compared to non-obese patients, obese individuals had greater prevalence of bacteraemia, UTI, and skin/soft tissue infection as compared to non-obese patients.


CONCLUSIONS
Obesity is newly identified to be independently associated with infection in end-stage liver disease. The distribution of infection sites varies based on weight category.
Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.|Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Sundaram
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Kaung
Department of Medicine, Touro College of Osteopathic Medicine, Henderson, NV, USA.
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Rajaram
Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.|Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Lu
Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.|Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Tran
Department of Surgery and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Nissen
Department of Surgery and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Klein
Liver Failure Group, Institute for Liver and Digestive Health, UCL Medical School, London, UK.
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Jalan
Department of Medicine, Intermountain Medical Center, Murray, UT, USA.
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Charlton
Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Jeon
D000368:Aged; D001424:Bacterial Infections / Q000453:epidemiology*; D003015:Clostridium Infections / Q000453:epidemiology; D016208:Databases, Factual; D058625:End Stage Liver Disease / Q000150:complications*; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011014:Pneumonia / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors