S1566 Patients With NAFLD Are at an Increased Risk of Helicobacter pylori Infections: Results From National Inpatient Sample Analysis

Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. Studies have reported an association between NAFLD and changes in the gut microbiome. H.pylori infection has also been observed to be a factor in the development of insulin resistance and non-alcoholic fatty liver disease. The current study aims to assess the relationship between the presence of NAFLD and the risk of Helicobacter pylori (HP) infection. Methods: National Inpatient Sample (NIS) database 2020 was used to stratify patients based on the presence of HP infection. Information was collected regarding patient demographics, hospital characteristics, Charlson comorbidity index, coexisting comorbidities (GERD, hyperlipidemia, tobacco use, diabetes, hypertension, obesity, obstructive sleep apnea(OSA), and inflammatory bowel disease (IBD)) as well as HP. Univariate and Multivariate analysis was performed to identify the relationship between NAFLD and HP infections after adjusting for confounding factors. Results: Out of 26 million patients, 24,910 patients had concomitant HP infection. The majority of the patients in the HP infection group were aged >65 years (46.1%), female (45.4%), had Medicare (41.9%) and were in the lowest income quartile (38.6%). There was a higher prevalence of NAFLD in patients with HP infection than those without (5.9% vs 2.9%, P< 0.001). There was a higher incidence of GERD, diabetes, and hypertension in the HPI group than those without (Table 1). After adjusting for confounding factors, the relationship between NAFLD and HP infection was noted to be statistically significant (aOR-1.58, 95% CI-1.41-1.79, P< 0.001). Other factors noted to be associated with HP infection included IBD, celiac disease, male gender, racial factors, and IBS. Diabetes, OSA, and obesity were noted to be associated with a reduced risk of HP infection (Figure 1). Conclusion: Our study demonstrated a notable increase in the risk of HP infections in patients with NAFLD. Since the data is cross-sectional, it is difficult to ascertain if HP infection is the cause or effect of NAFLD. Previous studies have noted a bidirectional relationship. Our study builds up on the previous data, and it is likely that these patients have microbiome alterations predisposing them to developing HP infections. Further prospective studies are needed to identify the causal relationship between these 2 conditions.Figure 1.: Results of multivariant logistic regression analyzing the association between H. Pylori and study variables. Table 1. - Patient characteristics and comorbidities, stratified by the presence of H. Pylori infection Demographics Absence of H.Pylori n (%) Presence of H. Pylori n (%) P- value Age category < 0.001 18-44 7530966 (28.52) 5265 (21.14) 45-64 7291281 (27.61) 9160 (36.77) >65 11585675 (43.87) 10485 (42.09) Sex < 0.001 Males 11499721 (43.55) 13590 (54.56) Females 14908201 (56.45) 11320 (45.44) Race < 0.001 White 17386322 (65.84) 9201 (36.97) Black 4163646 (15.77) 7385 (29.65) Hispanic 3121905 (11.82) 5035 (20.21) Asian/Pacific Islander 753370 (2.85) 1720 (6.90) Native American 180460 (0.68) 305 (1.22) Other 802220 (3.03) 1255 (5.03) Primary expected payer < 0.001 Medicare 12342984 (46.74) 10430 (41.87) Medicaid 4943690 (18.72) 6095 (24.47) Private 7090512 (26.85) 5300 (21.28) Uninsured 1112791 (4.21) 2125 (8.53) Median household income < 0.001 Lowest quartile 8076010 (30.58) 9610 (38.58) Second quartile 7173688 (27.16) 6150 (24.69) Third quartile 6040107 (22.87) 5315 (21.34) Highest quartile 5118117 (19.38) 3835 (15.4) Underlying comorbidity GERD 4971195 (18.82) 6380 (25.61) < 0.001 HLD 8691215 (32.91) 8140 (32.68) 0.74 Smoking 9615615 (36.41) 9910 (39.78) < 0.001 Diabetes 7526730 (28.5) 8055 (32.34) < 0.001 HTN 15035811 (56.94) 15500 (62.22) < 0.001 Obesity 4930814 (18.67) 4195 (16.84) 0.002 OSA 1966585 (7.44) 1230 (4.93) < 0.001 IBD 291230 (1.1) 335 (1.34) 0.11 Fatty Liver 754450 (2.85) 1460 (5.86) < 0.001