Liver and Bile

Eur J Gastroenterol Hepatol. 2024;36(2):220–8

Ma Z, Li M, Wang Y, Zou C, Wang Y, Guo T, Su Y, Zhang M, Meng Y, Jia J, Zhang J, Zou Z, Zhao X

Association of BMI with mortality in drug-induced liver injury

Background: To clarify the associations between body mass index (BMI) and the incidences of all-cause death or liver-related death (LRD)/liver transplantation (LT) in drug-induced liver injury (DILI).
Methods: DILI patients from 3 hospitals were retrospectively retrieved and follow-up from 2009 to 2021. They were categorized into underweight (BMI < 18.5 kg/m²), normal weight (BMI 18.5–23.9 kg/m²), overweight (BMI 24–27.9 kg/m²) and obese (BMI ≥ 28 kg/m²) groups. Cox regression models were conducted to reveal the effect of BMI on all-cause death or LRD/LT.
Results: A total of 1469 eligible DILI patients were included: underweight 73 (4.97%), normal weight 811 (55.21%), overweight 473 (32.20%) and obese 112 (7.62%). 89 patients (6.06%) had all-cause death, of which 66 patients (4.49%) had LRD/LT. The median age was 52 years, and 1039 patients (70.73%) were female. The associations between BMI and all-cause mortality (non-linear test p < 0.01) or liver-related mortality/LT (non-linear test p = 0.01) were J-shaped. Multivariate Cox regression analysis showed that underweight (hazard ratio [HR] = 3.02, 95% confidence interval [CI]: 1.51–6.02) was significantly associated with all-cause mortality after adjusting for age and sex. Furthermore, obese males were significantly associated with liver-related mortality/LT (HR = 3.49, 95% CI: 1.13–10.72) after additional adjustment for serological indices and comorbidities.

Conclusion: Association between body mass index (BMI) and mortality is a J-shape. The overall mortality was significantly higher in underweight and obese groups. Male obesity is independently associated with liver-related death/liver transplantation. These findings indicate that patients with drug-induced liver injury with extreme BMI would have a high risk of dismal outcomes, which warrants extra medical care.

Prof. Dr. Dr. X. Zhao, Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China, E-Mail: zhao_xinyan@ccmu.edu.cn

DOI: 10.1097/meg.0000000000002689

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Corpechot C, Lemoinne S, Soret PA, Hansen B, Hirschfield G, Gulamhusein A, Montano-Loza AJ, Lytvyak E, Pares A, Olivas I, Eaton JE, Osman KT, Schramm C, Sebode M, Lohse AW, Dalekos G, Gatselis N, Nevens F, Cazzagon N, Zago A, Russo FP, Floreani A, Abbas N, Trivedi P, Thorburn D, Saffioti F, Barkai L, Roccarina D, Calvaruso V, Fichera A, Delamarre A, Sobenko N, Villamil AM, Medina-Morales E, Bonder A, Patwardhan V, Rigamonti C, Carbone M, Invernizzi P, Cristoferi L, van der Meer A, de Veer R, Zigmond E, Yehezkel E, Kremer AE, Deibel A, Bruns T, Große K, Wetten A, Dyson JK, Jones D, Dumortier J, Pageaux GP, de Lédinghen V, Chazouillères O, Carrat F; Global & ERN Rare-Liver PBC Study Groups

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