Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Clin Mol Hepatol. 2024 Oct;30(4):929-942. doi: 10.3350/cmh.2024.0278. Epub 2024 Aug 27.
BACKGROUND/AIMS: Alcohol-associated liver disease (ALD) is a public health concern. ALD patients often have psychiatric comorbidities, but the effects of psychiatric interventions on ALD are not well-established. This study explores the prognostic impact of psychiatric intervention on ALD within UK Biobank cohort.
This population-based study included 2,417 ALD patients from the UK Biobank cohort. Psychiatric intervention was defined by a consultation with psychiatrists during hospitalization or a history of medication related to alcohol use disorder and psychiatric comorbidities. Survival analysis was conducted, incorporating propensity score matching (PSM), to precisely assess the impact of psychiatric intervention.
Among 2,417 ALD patients, those with F10 (mental disorders due to alcohol) codes had poorer survival outcomes. Psychiatric intervention significantly improved the outcomes of both all-cause and liver-related mortality and reduced the incidence of liver cirrhosis. In subgroup or 2-year landmark analyses, psychiatric intervention consistently showed a survival benefit in ALD patients. In the multivariate analysis, psychiatric intervention was identified as a favorable prognostic factor (hazard ratio, 0.780; P=0.002 after PSM).
This study demonstrates the favorable effect of psychiatric intervention in ALD patients with psychiatric comorbidities. These findings emphasize the importance of integrated management for ALD patients to address both their medical and psychiatric aspects. Therefore, we suggest the potential benefits of early psychiatric interventions in improving survival outcomes in ALD.
背景/目的：酒精相关性肝病 (ALD) 是一个公共卫生问题。ALD 患者常伴有精神共病，但精神干预对 ALD 的影响尚未得到充分证实。本研究旨在探讨 UK Biobank 队列中精神干预对 ALD 的预后影响。
本基于人群的研究纳入了来自 UK Biobank 队列的 2417 名 ALD 患者。精神干预的定义是住院期间与精神科医生的会诊或与酒精使用障碍和精神共病相关药物的使用史。采用倾向性评分匹配（PSM）进行生存分析，以准确评估精神干预的影响。
在 2417 名 ALD 患者中，F10（与酒精相关的精神障碍）编码的患者生存结局较差。精神干预显著改善了全因和肝脏相关死亡率，并降低了肝硬化的发生率。在亚组或 2 年时间点分析中，精神干预在 ALD 患者中始终显示出生存获益。多变量分析表明，精神干预是有利的预后因素（风险比，0.780；PSM 后 P=0.002）。
本研究表明精神干预对伴有精神共病的 ALD 患者具有有利影响。这些发现强调了对 ALD 患者进行综合管理以解决其医疗和精神方面问题的重要性。因此，我们建议早期精神干预可能有助于改善 ALD 的生存结局。
