Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
Digestive Care, HealthPartners, Bloomington, Minnesota, USA.
BMJ Open Gastroenterol. 2023 Feb;10(1). doi: 10.1136/bmjgast-2022-001083.
The incidence of alcohol-associated liver disease (ALD) is increasing, and weight loss surgery is more common due to the obesity epidemic. Roux-en-Y gastric bypass (RYGB) is associated with alcohol use disorder and ALD; however, its impact on outcomes in patients hospitalised for alcohol-associated hepatitis (AH) is unclear.
We performed a single-centre, retrospective study of patients with AH from June 2011 to December 2019. Primary exposure was the presence of RYGB. The primary outcome was inpatient mortality. Secondary outcomes included overall mortality, readmissions and cirrhosis progression.
2634 patients with AH met the inclusion criteria; 153 patients had RYGB. Median age of the entire cohort was 47.3 years; median Model for End Stage Liver Disease - Sodium (MELD-Na) was 15.1 in the study group versus 10.9 in the control group. There was no difference in inpatient mortality between the two groups. On logistic regression, increased age, elevated body mass index, MELD-Na >20 and haemodialysis were all associated with higher inpatient mortality. RYGB status was associated with increased 30-day readmission (20.3% vs 11.7%, p<0.01), development of cirrhosis (37.5% vs 20.9%, p<0.01) and overall mortality (31.4% vs 24%, p=0.03).
Patients with RYGB have higher rates of readmissions, cirrhosis and overall mortality after discharge from hospital for AH. Allocation of additional resources on discharge may improve clinical outcomes and reduce healthcare expenditure in this unique patient population.
由于肥胖症的流行，与酒精相关的肝病（ALD）的发病率正在上升，并且减肥手术更为常见。Roux-en-Y 胃旁路术（RYGB）与酒精使用障碍和 ALD 相关；然而，其对因酒精相关性肝炎（AH）住院患者结局的影响尚不清楚。
我们对 2011 年 6 月至 2019 年 12 月期间因 AH 住院的患者进行了一项单中心回顾性研究。主要暴露因素为 RYGB。主要结局为住院死亡率。次要结局包括总死亡率、再入院率和肝硬化进展。
符合纳入标准的 2634 例 AH 患者中，有 153 例接受了 RYGB。整个队列的中位年龄为 47.3 岁；研究组的中位终末期肝病模型钠（MELD-Na）为 15.1，对照组为 10.9。两组的住院死亡率无差异。Logistic 回归分析显示，年龄增加、体质量指数升高、MELD-Na>20 和血液透析均与住院死亡率升高相关。RYGB 状态与 30 天再入院率（20.3%比 11.7%，p<0.01）、肝硬化发生率（37.5%比 20.9%，p<0.01）和总死亡率（31.4%比 24%，p=0.03）升高相关。
RYGB 患者在因 AH 出院后再入院率、肝硬化和总死亡率较高。在出院时分配额外资源可能会改善这一独特患者群体的临床结局并降低医疗保健支出。
