Rath S. Elevated body mass index as a prognostic marker in acute liver failure: Implications from a two-decade cohort. World J Clin Cases 2025; 13(34): 113129 [DOI: 10.12998/wjcc.v13.i34.113129]
Corresponding Author of This Article
Shree Rath, MD, Department of Medicine, All India Institute of Medical Sciences Bhubaneswar, Sijua, Patrapada, Bhubaneswar 751019, Odisha, India. shreerath4a@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
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Letter to the Editor
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 6, 2025 (publication date) through Dec 9, 2025
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Publication Name
World Journal of Clinical Cases
ISSN
2307-8960
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Rath S. Elevated body mass index as a prognostic marker in acute liver failure: Implications from a two-decade cohort. World J Clin Cases 2025; 13(34): 113129 [DOI: 10.12998/wjcc.v13.i34.113129]
Elevated body mass index as a prognostic marker in acute liver failure: Implications from a two-decade cohort
Shree Rath
Shree Rath, Department of Medicine, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar 751019, Odisha, India
Author contributions: Rath S was responsible for conceptualization, data curation, writing and review of the manuscript.
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shree Rath, MD, Department of Medicine, All India Institute of Medical Sciences Bhubaneswar, Sijua, Patrapada, Bhubaneswar 751019, Odisha, India. shreerath4a@gmail.com
Received: August 18, 2025 Revised: September 14, 2025 Accepted: November 21, 2025 Published online: December 6, 2025 Processing time: 111 Days and 22.3 Hours
Abstract
The prognostic impact of obesity in acute liver failure (ALF) remains underexplored in recent United States cohorts despite the global rise in obesity prevalence. The aim of this letter is to appraise and contextualize the findings of Krishnan et al, who examined the association between body mass index (BMI) and ALF outcomes in a large, retrospective United States cohort. Krishnan et al analyzed 196 ALF patients over two decades, demonstrating that both overweight and obesity independently doubled the risk of death or need for liver transplantation after adjustment for confounders. Elevated BMI was also associated with higher grades of hepatic encephalopathy and renal dysfunction; two major contributors to ALF mortality. Future research should consider additional markers of metabolic health beyond BMI to refine prognostication. This study provides timely, robust evidence linking elevated BMI to adverse ALF outcomes and highlights the need for targeted clinical strategies in this vulnerable subgroup.
Core Tip: The association between elevated body mass index (BMI) and poor outcomes in acute liver failure (ALF) has been underexplored in recent literature. Krishnan et al present a large, two-decade United States cohort showing that overweight and obese patients face a twofold higher risk of death or need for liver transplantation, along with greater prevalence of severe hepatic encephalopathy and renal dysfunction. These findings highlight BMI as an important prognostic marker in ALF and support its integration into risk assessment frameworks. Targeted monitoring and early interventions in this population may help mitigate adverse outcomes.
