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

被引：28

作者：

Pearson, Meredith M. ^{[1
]}

Kim, Nicole J. ^{[1
]}

Berry, Kristin ^{[2
]}

Moon, Andrew M. ^{[3
]}

Su, Feng ^{[1
]}

Vutien, Philip ^{[1
]}

Green, Pamela K. ^{[2
]}

Williams, Emily C. ^{[2
,4
]}

Ioannou, George N. ^{[1
,5
]}

机构：

[1] Univ Washington, Div Gastroenterol & Hepatol, Seattle, WA 98195 USA

[2] Vet Affairs Puget Sound Hlth Care Syst, Hlth Serv Res & Dev, Seattle, WA USA

[3] Univ N Carolina, Div Gastroenterol & Hepatol, Chapel Hill, NC 27515 USA

[4] Univ Washington, Dept Hlth Serv, Seattle, WA 98195 USA

[5] Vet Affairs Puget Sound Hlth Care Syst, Div Gastroenterol, Seattle, WA USA

来源：

HEPATOLOGY COMMUNICATIONS | 2021年 / 5卷 / 12期

基金：

美国国家卫生研究院;

关键词：

CHRONIC HEPATITIS-C; HEPATOCELLULAR-CARCINOMA; RISK-FACTORS; VIRUS-INFECTION; USE DISORDER; CONSUMPTION; PROGRESSION; PREDICTION; MORTALITY; DISEASE;

D O I：

10.1002/hep4.1776

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

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.

引用

页码：2080 / 2095

页数：16