D0502 - Is Non-Alcoholic Fatty Liver Disease a Risk Factor for Ascending Cholangitis? A National Retrospective Cohort Study

Pratik Patel, MD¹, Hassam Ali, MD², Rahul Pamarthy, MD², Shiva Poola, MD³, Karina Fatakhova, MD, MBA⁴, Sanjaya Satapathy, MBBS, MD, DM, MS^5
1Northwell Health at Mather Hospital, Middle Island, NY; ²East Carolina University, Greenville, NC; ³ECU Health Medical Center/Brody School of Medicine, Greenville, NC; ⁴Mather Hospital, Northwell Health, Port Jefferson, NY; ⁵Northwell Health, Manhasset, NY

Introduction: Non-alcoholic fatty liver disease (NAFLD) represents a spectrum of liver disease that ranges from simple fat deposition in the liver, to fibrosis and even decompensated cirrhosis. While studies have suggested a relationship between ascending cholangitis (AC) and NAFLD in patients with choledocholithiasis, the association between NAFLD and ascending cholangitis (AC) independent of choledocholithiasis has not yet been evaluated. This study investigated the association, risk factors and mortality of AC in patients with and without NAFLD.

Methods: We conducted a retrospective study using the National Inpatient Sample (NIS) database, to analyze adult patients (≥18 years of age) with a diagnosis of AC and NAFLD from Jan 1, 2016, to Dec 31, 2019. Patients were split into two cohorts based on the presence or absence of NAFLD. Exclusion criteria included alcoholic or viral liver disease in both cohorts to accurately compare independent effects of NAFLD on AC outcomes. Furthermore, patients were excluded if they had toxic liver disease, biliary cirrhosis, liver infarction, or liver transplant as defined by the International Classification of Diseases tenth edition (ICD-10) coding systems.

Results: A total of 162,110 cases of AC were included in our study. Of these, 0.14% of cases had NAFLD as a comorbid condition after the patient selection process. There was an increased association of NAFLD with AC compared to patients without NAFLD, aOR 2.81 (95% CI [2.51-3.14], P < 0.001). Or study revealed revealed significantly higher mortality among the NAFLD cohort (5% vs. 4%, P = 0.03). There was also a higher association of portal vein thrombosis (aOR 4.17 [95% CI 2.55-6.81], P < 0.001), acute renal failure (aOR 1.83 [95% CI 1.45-2.31], P < 0.001), vasopressor use (aOR 2.11 [95% CI 1.18-3.75], P = 0.01), and mechanical ventilation (aOR 2.14 [95% CI 1.38-3.31], P = 0.001) in NAFLD patients compared to the control.

Discussion: We found that patients with NAFLD were at a higher risk of developing ascending cholangitis than patients without NAFLD. Additionally, patients with NAFLD had increased length of stay, mean inpatient cost, medical co-morbidities and acute complications. Given the rising prevalence of NAFLD in the United States, future work should focus on delaying the progression of NAFLD. Reversal of steatosis and fibrosis through newer pharmacotherapy could help prevent future complications such as AC.



Disclosures:


Pratik Patel, MD¹, Hassam Ali, MD², Rahul Pamarthy, MD², Shiva Poola, MD³, Karina Fatakhova, MD, MBA⁴, Sanjaya Satapathy, MBBS, MD, DM, MS⁵. D0502 - Is Non-Alcoholic Fatty Liver Disease a Risk Factor for Ascending Cholangitis? A National Retrospective Cohort Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.