Twohig Patrick A, Balasanova Alena, Cooper Lauren, Le Michelle, Khoury Nathalie, Manatsathit Wuittporn, Olivera Marco, Peeraphatdit Thoetchai Bee
From the Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE (PAT, LC, ML, NK, WM, MO, TBP); and Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE (AB).
J Addict Med. 2025;19(1):35-40. doi: 10.1097/ADM.0000000000001371. Epub 2024 Aug 16.
Alcohol-associated liver disease (ALD) is the most common indication for liver transplantation in the United States. Alcohol use disorder (AUD) treatment is recommended in all patients with ALD and AUD, but it remains underutilized.
To identify predictors of AUD treatment and to assess 30-day readmission, return to drinking, and 1-year transplant-free survival.
Retrospective single-center cohort study of consecutive patients hospitalized with ALD and AUD between 2018 and 2020. Patients who died or were lost to follow-up at 90 days after hospitalization were excluded. AUD treatment was defined as receiving medication or participating in residential, outpatient, or support groups within 90 days of discharge.
One hundred nine patients were included. Mean age was 51.7 years, and 63% were male. Fifty-six (51%) patients received AUD treatment, and 23 (21%) patients received more than one treatment. Predictors of AUD treatment were younger age (OR, 1.07 [95% CI, 1.04-1.12]; P < 0.001), gastroenterology/hepatology consult (AOR, 8.54 [95% CI, 2.55-39.50]; P = 0.0002), addiction psychiatry consult (AOR, 2.77 [95% CI, 1.16-6.84]; P = 0.02), and a brief AUD intervention (AOR, 18.19 [95% CI, 3.36-339.07]; P = 0.0001). Cirrhosis decompensation, MELD-Na score, and insurance status were not associated with treatment. Thirty-one patients (28.4%) were readmitted, and 29 (26.6%) remained abstinent 30 days from discharge. Patients who received treatment had improved transplant-free survival (HR, 0.44, P = 0.04).
A brief intervention on AUD had the strongest association with receiving AUD treatment in our cohort. Further efforts to incorporate brief interventions when offering AUD treatment to patients with ALD may be beneficial.
酒精性肝病（ALD）是美国肝移植最常见的适应症。建议对所有患有ALD和酒精使用障碍（AUD）的患者进行AUD治疗，但该治疗仍未得到充分利用。
确定AUD治疗的预测因素，并评估30天再入院率、复饮情况和1年无移植生存率。
对2018年至2020年间因ALD和AUD住院的连续患者进行回顾性单中心队列研究。排除住院后90天内死亡或失访的患者。AUD治疗定义为出院后90天内接受药物治疗或参加住院、门诊或支持小组。
纳入109例患者。平均年龄51.7岁，63%为男性。56例（51%）患者接受了AUD治疗，23例（21%）患者接受了不止一种治疗。AUD治疗的预测因素为年龄较小（OR，1.07 [95% CI，1.04 - 1.12]；P < 0.001）、胃肠病学/肝病学会诊（AOR，8.54 [95% CI，2.55 - 39.50]；P = 0.0002）、成瘾精神病学会诊（AOR，2.77 [95% CI，1.16 - 6.84]；P = 0.02）和简短的AUD干预（AOR，18.19 [95% CI，3.36 - 339.07]；P = 0.0001）。肝硬化失代偿、MELD-Na评分和保险状况与治疗无关。31例患者（28.4%）再次入院，29例（26.6%）出院后30天保持戒酒。接受治疗的患者无移植生存率有所提高（HR，0.44，P = 0.04）。
在我们的队列中，对AUD的简短干预与接受AUD治疗的关联最强。在为ALD患者提供AUD治疗时，进一步努力纳入简短干预可能是有益的。
