Elevated body mass index as a prognostic marker in acute liver failure: Implications from a two-decade cohort

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.