Risk of mortality among patients with alcohol-associated hepatitis in the US from 2007 to 2021

• Published in: Alcohol (Fayetteville, N.Y.) Vol. 120; pp. 143 - 150
• Main Authors: Tu, Wanzhu, Liangpunsakul, Suthat, Nguyen, Chi Mai, Healey, Ryan, Li, Yang, Radaeva, Svetlana, Gawrieh, Samer, Bataller, Ramon, Su, Jing
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2024; Elsevier Limited
• Subjects: Alcohol; Alcohol-associated hepatitis; Chronic obstructive pulmonary disease; Codes; Diagnosis; Electronic health records; Hepatitis; Hospitalization; Insurance coverage; Laboratories; Liver diseases; Medical prognosis; Medicare; Metastasis; Mortality; Observational studies; Patients; Prognosis; Risk factors; United States > US; Alcohol-associated hepatitis; Mortality; Prognosis
• ISSN: 0741-8329; 1873-6823; 1873-6823
• DOI: 10.1016/j.alcohol.2024.06.006

Alcohol-associated hepatitis (AH) mortality and risk factors have not been carefully studied in real-world settings. We examined the rate, temporal trend, and risk factors of mortality in AH.
We conducted a cohort study of individuals with AH diagnoses using medical claims data from Optum's Clinformatics® Data Mart (CDM). Participants were individuals covered by Medicare Advantage and commercial insurance policies. Cases were identified using diagnostic codes. Cox regressions were used to estimate 90 and 180-day mortality rates by hospitalization status.
The cohort included 32,001 patients (72% men) who had at least one year of continuous insurance coverage prior to AH diagnoses. Of these, 20,912 were hospitalized within seven days of diagnosis. Ninety and 180-day mortality rates were 12.0% (95% CI [11.6%, 12.5%]) and 16.0% (95% CI [15.4%, 16.5%]), respectively, for the hospitalized patients and 3.1% (95% CI [2.8%, 3.4%]) and 5.1% (95% CI [4.6%, 5.5%]) for the non-hospitalized patients. Pre-existing liver disease, even in a mild form, was associated with an increased risk of death. In hospitalized patients, a history of mild liver disease was associated with a 24% increase in 180-day mortality risk (HR = 1.24, 95% CI: [1.14, 1.36]). Moderate-to-severe liver disease was associated with a more than doubled risk (HR = 2.33, 95% CI: [2.12, 2.56]).
History of liver disease was associated with significantly increased AH mortality. The finding highlights the chronic disease context of AH and suggests that prior diagnosis of liver disease should be considered for prognosis and targeted prevention.
•Prior diagnoses of liver diseases are associated with more than doubled mortality rates in patients with alcohol-associated hepatitis.•Considering the fact that most of the existing prognostic models are based on biochemistry markers, the present study highlights the importance of including liver disease history in AH prognosis.•The finding may also have implications for targeted interventions in those with heightened risk.