Kaye Alexander J, Patel Shivani, Meyers Sarah, Rim Daniel, Choi Catherine, Ahlawat Sushil
Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA.
Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, USA.
Cureus. 2022 May 27;14(5):e25418. doi: 10.7759/cureus.25418. eCollection 2022 May.
Alcoholic hepatitis (AH) is a common cause of hospital admissions and is associated with a high mortality rate. AH occurs frequently in patients with heavy alcohol use. Alcohol use disorder (AUD) commonly presents with comorbid psychiatric disorders such as bipolar disorder. Bipolar disorder patients are also known to be at an increased risk for chronic liver diseases. Bipolar 1 disorder (B1D) is often considered the most severe presentation among different types of bipolar disorder. This study assesses the clinical outcomes of patients admitted for AH with concomitant B1D.
Adult patients with AH were identified within the 2014 National Inpatient Sample (NIS) database. International Classification of Diseases, Ninth Edition Revision, Clinical Modification (ICD-9 CM) codes were used to select for all of the diagnoses for this study. AH patients were subdivided into those with and without B1D. The outcomes of interest were sepsis, hepatic encephalopathy, acute respiratory failure, acute kidney injury, ischemic stroke, hepatic failure, coagulopathy, and inpatient mortality. A multivariate logistic regression analysis was performed to explore whether B1D is an independent predictor for the outcomes.
Among 4,453 patients with AH identified, 166 patients also had B1D. AH patients with comorbid B1D were seen to be younger (42.9 years old vs. 46.2 years old, p < 0.05) and more commonly female (55.4% vs. 36.5%, p < 0.05). The B1D subgroup of AH patients were found to less likely develop acute hepatic failure (adjusted odds ratio (aOR) 0.13, 95% confidence interval (CI): 0.02-0.97, p < 0.05). The adjusted odds ratios for the remaining outcomes were not statistically significant.
Our study indicates that B1D may be an independent protective factor against acute hepatic failure in patients hospitalized with AH. This finding can be explained by frequent laboratory monitoring and psychiatric assessments performed by psychiatrists treating B1D patients, as well as the impact B1D has on cortisol release induced by hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis.
酒精性肝炎（AH）是住院的常见原因，且死亡率很高。AH在大量饮酒的患者中经常出现。酒精使用障碍（AUD）通常伴有双相情感障碍等共病精神障碍。双相情感障碍患者患慢性肝病的风险也会增加。双相I型障碍（B1D）通常被认为是不同类型双相情感障碍中最严重的表现形式。本研究评估了合并B1D的AH住院患者的临床结局。
在2014年全国住院患者样本（NIS）数据库中识别出成年AH患者。使用国际疾病分类第九版临床修订本（ICD-9 CM）编码来选择本研究的所有诊断。AH患者被分为合并B1D和未合并B1D两组。感兴趣的结局包括败血症、肝性脑病、急性呼吸衰竭、急性肾损伤、缺血性中风、肝衰竭、凝血障碍和住院死亡率。进行多因素逻辑回归分析以探讨B1D是否是这些结局的独立预测因素。
在识别出的4453例AH患者中，有166例同时患有B1D。合并B1D的AH患者年龄更小（42.9岁对46.2岁，p<0.05），女性更为常见（55.4%对36.5%，p<0.05）。发现AH患者的B1D亚组发生急性肝衰竭的可能性较小（调整后的优势比（aOR）为0.13，95%置信区间（CI）：0.02-0.97，p<0.05）。其余结局的调整后的优势比无统计学意义。
我们的研究表明，B1D可能是AH住院患者急性肝衰竭的独立保护因素。这一发现可以通过治疗B1D患者的精神科医生进行的频繁实验室监测和精神评估，以及B1D对下丘脑-垂体-肾上腺（HPA）轴功能亢进诱导的皮质醇释放的影响来解释。
