Feng Xiaoshan, Xuan Ruirui, Dong Yingchun, Wu Xiaoqin, Cheng Yiping, Yuan Zinuo, Dong Hang, Han Junming, Zhong Fang, Zhao Jiajun, Fan Xiude
Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China.
Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan 250021, China.
Diagnostics (Basel). 2023 Jan 29;13(3):488. doi: 10.3390/diagnostics13030488.
(1) Background: As the introduction of "positive" diagnostic criteria for metabolic dysfunction-associated fatty liver disease (MAFLD) does not exclude alcohol consumption, some patients originally diagnosed with alcoholic fatty liver disease (AFLD) may be diagnosed with dual- etiology fatty liver disease (AFLD&MAFLD), which requires us to urgently explore the impact of the changes in this classification of AFLD on clinical manifestations. (2) Methods: Utilizing data from the Nationwide Inpatient Sample database 2016-2018, a total of 9269 participants with AFLD were selected. With the definition of MAFLD, these patients were further categorized into two groups: single AFLD and AFLD&MAFLD. The primary outcome was the risk of comorbidities and organ failures. The secondary outcomes were the length of stay, total charges, and in-hospital all-cause mortality. (3) Results: The patients with AFLD&MAFLD were older, were predominantly male, and had more comorbidities and organ failures compared to the patients with AFLD. These comorbidities included coronary atherosclerosis, myocardial infarction, cerebrovascular disease, arrhythmia, asthma, chronic obstructive pulmonary disease, and chronic kidney disease (all values < 0.05). The patients with AFLD&MAFLD were more likely to develop acute and chronic heart and/or kidney failures than those with single AFLD (all < 0.05). The length of stay and total charges of the patients in the AFLD&MAFLD group were greater than the single AFLD group ( = 0.029 and < 0.001, respectively). No significant difference in all-cause mortality was observed. (4) Conclusions: The patients with AFLD&MAFLD have more comorbidities and organ failures, longer hospital stays, and higher hospitalization costs than the patients with single AFLD. Hence, patients with dual-etiology fatty liver disease deserve more attention from clinical staff during treatment.
（1）背景：由于代谢功能障碍相关脂肪性肝病（MAFLD）“阳性”诊断标准的引入并未排除饮酒因素，一些原本被诊断为酒精性脂肪性肝病（AFLD）的患者可能会被诊断为双病因脂肪性肝病（AFLD&MAFLD），这就要求我们迫切探索AFLD这种分类变化对临床表现的影响。（2）方法：利用2016 - 2018年全国住院患者样本数据库的数据，共选取了9269例AFLD患者。根据MAFLD的定义，将这些患者进一步分为两组：单纯AFLD组和AFLD&MAFLD组。主要结局是合并症和器官衰竭的风险。次要结局是住院时间、总费用和院内全因死亡率。（3）结果：与AFLD患者相比，AFLD&MAFLD患者年龄更大，以男性为主，合并症和器官衰竭更多。这些合并症包括冠状动脉粥样硬化、心肌梗死、脑血管疾病、心律失常、哮喘、慢性阻塞性肺疾病和慢性肾脏病（所有P值<0.05）。与单纯AFLD患者相比，AFLD&MAFLD患者更易发生急性和慢性心脏和/或肾衰竭（所有P<0.05）。AFLD&MAFLD组患者的住院时间和总费用均高于单纯AFLD组（分别为P = 0.029和P<0.001）。全因死亡率未观察到显著差异。（4）结论：与单纯AFLD患者相比，AFLD&MAFLD患者合并症和器官衰竭更多，住院时间更长，住院费用更高。因此，双病因脂肪性肝病患者在治疗期间值得临床工作人员给予更多关注。
