The Influence of Insulin Resistance on Outcomes in Hospitalizations for Alcohol-Related Liver Disease: A Nationwide Study

Background Alcoholic liver disease (ALD) is known to contribute to the onset of insulin resistance (IR), which has been speculated to worsen the outcome of the disease. This study examines the impact of IR on the severity and outcomes of hospitalizations for ALD. Methods A retrospective study was performed using the combined 2016 to 2018 Nationwide Inpatient Sample. All admissions for ALD were included. The association between IR and the clinical and resource utilization of hospitalizations for ALD was analyzed using multivariate regression models to adjust for confounding variables. Results About 294,864 hospitalizations for ALD were analyzed. Of these, 383 cases (0.13%) included a secondary diagnosis of IR, while the remaining 294,481 hospitalizations (99.87%) were considered as controls. The incidence of IR in the study was 1.3 per 1000 admissions for ALD. IR was not associated with any significant difference in the likelihood of mortality (adjusted odds ratio (aOR): 1.10, 95% confidence interval (CI): 0.370-3.251, p=0.867), acute liver failure, or the incidence of complications (aOR: 0.83, 95% CI: 0.535-1.274, p<0.001). However, the study found that ALD hospitalizations with IR had longer hospital stays (7.3 days vs. 6.0 days: IRR, 1.17; 95% CI, 1.09-1.26; p<0.001) and higher mean hospital costs ($91,124 vs. $65,290: IRR, 1.32; 95% CI, 1.20-1.46; p<0.001) compared to patients without IR. Conclusion IR alone does not worsen the outcomes of patients with ALD, and its association with longer hospital stays and higher mean hospital costs could be due to other confounding factors.