Department of Biostatistics & Health Data, Indiana University School of Medicine, Indianapolis, IN 46202, USA; Regenstrief Institute, Inc., Indianapolis, IN 46202, USA.
Roudebush Veterans Administration Medical Center, Indianapolis, IN 46202, USA; Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
Alcohol. 2024 Nov;120:143-150. doi: 10.1016/j.alcohol.2024.06.006. Epub 2024 Jun 20.
BACKGROUND/AIMS: Alcohol-associated hepatitis (AH) mortality and risk factors have not been carefully studied in real-world settings. We examined the rate, temporal trend, and risk factors of mortality in AH.
We conducted a cohort study of individuals with AH diagnoses using medical claims data from Optum's Clinformatics® Data Mart (CDM). Participants were individuals covered by Medicare Advantage and commercial insurance policies. Cases were identified using diagnostic codes. Cox regressions were used to estimate 90 and 180-day mortality rates by hospitalization status.
The cohort included 32,001 patients (72% men) who had at least one year of continuous insurance coverage prior to AH diagnoses. Of these, 20,912 were hospitalized within seven days of diagnosis. Ninety and 180-day mortality rates were 12.0% (95% CI [11.6%, 12.5%]) and 16.0% (95% CI [15.4%, 16.5%]), respectively, for the hospitalized patients and 3.1% (95% CI [2.8%, 3.4%]) and 5.1% (95% CI [4.6%, 5.5%]) for the non-hospitalized patients. Pre-existing liver disease, even in a mild form, was associated with an increased risk of death. In hospitalized patients, a history of mild liver disease was associated with a 24% increase in 180-day mortality risk (HR = 1.24, 95% CI: [1.14, 1.36]). Moderate-to-severe liver disease was associated with a more than doubled risk (HR = 2.33, 95% CI: [2.12, 2.56]).
History of liver disease was associated with significantly increased AH mortality. The finding highlights the chronic disease context of AH and suggests that prior diagnosis of liver disease should be considered for prognosis and targeted prevention.
背景/目的：酒精相关性肝炎（AH）的死亡率和危险因素尚未在真实环境中得到仔细研究。本研究旨在探讨 AH 患者的死亡率、时间趋势和危险因素。
我们使用 Optum 的 Clinformatics® Data Mart（CDM）中的医疗索赔数据，对 AH 诊断患者进行了队列研究。参与者为接受 Medicare Advantage 和商业保险的人群。使用诊断代码识别病例。使用 Cox 回归估计住院和非住院患者的 90 天和 180 天死亡率。
队列包括 32001 名（72%为男性）至少有一年连续保险覆盖的患者，其中 20912 名患者在 AH 诊断后 7 天内住院。住院和非住院患者的 90 天和 180 天死亡率分别为 12.0%（95%CI [11.6%, 12.5%]）和 16.0%（95%CI [15.4%, 16.5%]），3.1%（95%CI [2.8%, 3.4%]）和 5.1%（95%CI [4.6%, 5.5%]）。即使是轻度的预先存在的肝病也与死亡风险增加相关。在住院患者中，轻度肝病病史与 180 天死亡率增加 24%相关（HR=1.24，95%CI：[1.14，1.36]）。中度至重度肝病与风险增加两倍以上相关（HR=2.33，95%CI：[2.12，2.56]）。
肝病病史与 AH 死亡率显著增加相关。这一发现强调了 AH 的慢性疾病背景，并表明应考虑先前诊断的肝病对预后和针对性预防的影响。
