Associations Between Alcohol Use and Liver‐Related Outcomes in a Large National Cohort of Patients With Cirrhosis

Alcohol use can cause hepatic necroinflammation and worsening portal hypertension in patients with cirrhosis. We aimed to evaluate the associations between degree of alcohol use and clinical liver‐related outcomes according to etiology of cirrhosis. In this retrospective cohort analysis, 44,349 U.S....

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Autores principales:	Meredith M. Pearson, Nicole J. Kim, Kristin Berry, Andrew M. Moon, Feng Su, Philip Vutien, Pamela K. Green, Emily C. Williams, George N. Ioannou
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/e9336f6a34c34664b99707504a4f2b47
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spelling	oai:doaj.org-article:e9336f6a34c34664b99707504a4f2b472021-11-30T13:39:17ZAssociations Between Alcohol Use and Liver‐Related Outcomes in a Large National Cohort of Patients With Cirrhosis2471-254X10.1002/hep4.1776https://doaj.org/article/e9336f6a34c34664b99707504a4f2b472021-12-01T00:00:00Zhttps://doi.org/10.1002/hep4.1776https://doaj.org/toc/2471-254XAlcohol use can cause hepatic necroinflammation and worsening portal hypertension in patients with cirrhosis. We aimed to evaluate the associations between degree of alcohol use and clinical liver‐related outcomes according to etiology of cirrhosis. In this retrospective cohort analysis, 44,349 U.S. veterans with cirrhosis from alcohol‐associated liver disease (ALD), chronic hepatitis C virus (HCV) infection, or nonalcoholic fatty liver disease were identified who completed the Alcohol Use Disorders Identification Test Consumption questionnaire in 2012. Based on this score, level of alcohol use was categorized as none, low level, or unhealthy. Multivariable Cox proportional hazards regression was used to assess for associations between alcohol use and mortality, cirrhosis decompensation (new ascites, encephalopathy, or variceal bleeding), and hepatocellular carcinoma (HCC). At baseline, 36.4% of patients endorsed alcohol use and 17.1% had unhealthy alcohol use. During a mean 4.9 years of follow‐up, 25,806 (57.9%) patients died, 9,409 (21.4%) developed a new decompensation, and 4,733 (11.1%) developed HCC. In patients with ALD‐cirrhosis and HCV‐cirrhosis, unhealthy alcohol use, compared with no alcohol use, was associated with higher risks of mortality (adjusted hazard ratio [aHR] = 1.13, 95% confidence interval [CI] = 1.07‐1.19 and aHR = 1.14, 95% CI = 1.08‐1.20, respectively) and decompensation (aHR = 1.18, 95% CI = 1.07‐1.30 and aHR = 1.08, 95% CI = 1.00‐1.16, respectively). Alcohol use was not associated with HCC, regardless of cirrhosis etiology. Conclusion: Unhealthy alcohol use was common in patients with cirrhosis and was associated with higher risks of mortality and cirrhosis decompensation in patients with HCV‐cirrhosis and ALD‐cirrhosis. Therefore, health care providers should make every effort to help patients achieve abstinence. The lack of association between alcohol use and HCC merits further investigation.Meredith M. PearsonNicole J. KimKristin BerryAndrew M. MoonFeng SuPhilip VutienPamela K. GreenEmily C. WilliamsGeorge N. IoannouWileyarticleDiseases of the digestive system. GastroenterologyRC799-869ENHepatology Communications, Vol 5, Iss 12, Pp 2080-2095 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	Diseases of the digestive system. Gastroenterology RC799-869 Meredith M. Pearson Nicole J. Kim Kristin Berry Andrew M. Moon Feng Su Philip Vutien Pamela K. Green Emily C. Williams George N. Ioannou Associations Between Alcohol Use and Liver‐Related Outcomes in a Large National Cohort of Patients With Cirrhosis
description	Alcohol use can cause hepatic necroinflammation and worsening portal hypertension in patients with cirrhosis. We aimed to evaluate the associations between degree of alcohol use and clinical liver‐related outcomes according to etiology of cirrhosis. In this retrospective cohort analysis, 44,349 U.S. veterans with cirrhosis from alcohol‐associated liver disease (ALD), chronic hepatitis C virus (HCV) infection, or nonalcoholic fatty liver disease were identified who completed the Alcohol Use Disorders Identification Test Consumption questionnaire in 2012. Based on this score, level of alcohol use was categorized as none, low level, or unhealthy. Multivariable Cox proportional hazards regression was used to assess for associations between alcohol use and mortality, cirrhosis decompensation (new ascites, encephalopathy, or variceal bleeding), and hepatocellular carcinoma (HCC). At baseline, 36.4% of patients endorsed alcohol use and 17.1% had unhealthy alcohol use. During a mean 4.9 years of follow‐up, 25,806 (57.9%) patients died, 9,409 (21.4%) developed a new decompensation, and 4,733 (11.1%) developed HCC. In patients with ALD‐cirrhosis and HCV‐cirrhosis, unhealthy alcohol use, compared with no alcohol use, was associated with higher risks of mortality (adjusted hazard ratio [aHR] = 1.13, 95% confidence interval [CI] = 1.07‐1.19 and aHR = 1.14, 95% CI = 1.08‐1.20, respectively) and decompensation (aHR = 1.18, 95% CI = 1.07‐1.30 and aHR = 1.08, 95% CI = 1.00‐1.16, respectively). Alcohol use was not associated with HCC, regardless of cirrhosis etiology. Conclusion: Unhealthy alcohol use was common in patients with cirrhosis and was associated with higher risks of mortality and cirrhosis decompensation in patients with HCV‐cirrhosis and ALD‐cirrhosis. Therefore, health care providers should make every effort to help patients achieve abstinence. The lack of association between alcohol use and HCC merits further investigation.
format	article
author	Meredith M. Pearson Nicole J. Kim Kristin Berry Andrew M. Moon Feng Su Philip Vutien Pamela K. Green Emily C. Williams George N. Ioannou
author_facet	Meredith M. Pearson Nicole J. Kim Kristin Berry Andrew M. Moon Feng Su Philip Vutien Pamela K. Green Emily C. Williams George N. Ioannou
author_sort	Meredith M. Pearson
title	Associations Between Alcohol Use and Liver‐Related Outcomes in a Large National Cohort of Patients With Cirrhosis
title_short	Associations Between Alcohol Use and Liver‐Related Outcomes in a Large National Cohort of Patients With Cirrhosis
title_full	Associations Between Alcohol Use and Liver‐Related Outcomes in a Large National Cohort of Patients With Cirrhosis
title_fullStr	Associations Between Alcohol Use and Liver‐Related Outcomes in a Large National Cohort of Patients With Cirrhosis
title_full_unstemmed	Associations Between Alcohol Use and Liver‐Related Outcomes in a Large National Cohort of Patients With Cirrhosis
title_sort	associations between alcohol use and liver‐related outcomes in a large national cohort of patients with cirrhosis
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/e9336f6a34c34664b99707504a4f2b47
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Associations Between Alcohol Use and Liver‐Related Outcomes in a Large National Cohort of Patients With Cirrhosis

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