Vannier Augustin G L, Fomin Vladislav, Chung Raymond T, Patel Suraj J, Schaefer Esperance, Goodman Russell P, Luther Jay
MGH Alcohol Liver Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
Gastro Hep Adv. 2022;1(3):403-408. doi: 10.1016/j.gastha.2022.02.004. Epub 2022 Mar 30.
Substance use disorder (SUD) commonly associates with alcohol use disorder (AUD), and certain substances have independently been shown to drive liver injury. In this work, we sought to determine if co-existing SUD in patients with AUD associated with the presence of alcohol-associated liver disease (ALD).
We performed a cross-sectional analysis using the Mass General Brigham Biobank to identify patients based on ICD-10 codes. We performed multivariate analyses accounting for a wide range of demographic and clinical variables to evaluate the association between SUD and ALD. We subsequently used the same method to evaluate the association between SUD and hepatic decompensation.
We identified 2848 patients with a diagnosis of AUD, 9.0% of which had ALD. 25.2% had a history of SUD. In multivariate analyses, patients with SUD were more frequently diagnosed with ALD compared to those without SUD (OR = 1.95, P = 0.001). Furthermore, the number of concurrent SUDs was positively associated with the diagnosis of ALD (OR: 1.33, P < 0.001). Independent of the presence of other SUDs, opioid use disorder in patients with AUD was associated with ALD (OR = 1.902, P = 0.02). In subsequent analyses, we found that sedative use disorder was associated with hepatic decompensation (OR: 2.068, P = 0.03).
In patients with AUD, SUD, and in particular opioid use disorder, was independently associated with the diagnosis of ALD.
物质使用障碍（SUD）常与酒精使用障碍（AUD）相关联，并且某些物质已被独立证明会导致肝损伤。在本研究中，我们试图确定AUD患者中并存的SUD是否与酒精性肝病（ALD）的存在相关。
我们使用麻省总医院布莱根生物样本库进行横断面分析，根据国际疾病分类第十版（ICD - 10）编码识别患者。我们进行了多变量分析，纳入了广泛的人口统计学和临床变量，以评估SUD与ALD之间的关联。随后，我们使用相同方法评估SUD与肝失代偿之间的关联。
我们识别出2848例诊断为AUD的患者，其中9.0%患有ALD。25.2%有SUD病史。在多变量分析中，与无SUD的患者相比，有SUD的患者更常被诊断为ALD（比值比[OR] = 1.95，P = 0.001）。此外，并存的SUD数量与ALD的诊断呈正相关（OR：1.33，P < 0.001）。独立于其他SUD的存在，AUD患者中的阿片类物质使用障碍与ALD相关（OR = 1.902，P = 0.02）。在后续分析中，我们发现镇静剂使用障碍与肝失代偿相关（OR：2.068，P = 0.03）。
在AUD患者中，SUD，尤其是阿片类物质使用障碍，与ALD的诊断独立相关。
