Houston Kevin, Harris Spencer, Teklezghi Adonay, Silvey Scott, Snyder Andrew D, Arias Albert J, Bajaj Jasmohan S
School of Medicine, Richmond VA Medical Center, Virginia Commonwealth University, Richmond, Virginia, USA.
Department of Internal Medicine, Richmond VA Medical Center, Virginia Commonwealth University, Richmond, Virginia, USA.
Alcohol Clin Exp Res (Hoboken). 2024 Oct;48(10):1898-1904. doi: 10.1111/acer.15422. Epub 2024 Sep 21.
Alcohol use disorder (AUD) is a multifaceted disease, and integration of AUD treatment between mental health and hepatology is necessary to improve outcomes. We aimed to ascertain whether patients with excessive alcohol use (EAU) and high FIB-4, which is a non-invasive method to identify advanced liver disease, are appropriately referred to hepatology and detect which clinical barriers, if any, might pertain.
Records of patients with excessive alcohol use between 2013 and 2023 were extracted from a large public system. Demographics, alcohol-related hospitalizations, mental health conditions, Charlson comorbidity index (CCI) and referral patterns were evaluated. Comparisons were made between those referred to hepatology versus not.
1131 subjects showed evidence of EAU but on further review, 189 were in alcohol-remission. The remaining 942 (636 men, age 55.7 ± 14.5 years, 548 white, 363 black, 19 Hispanic) subjects with CCI 2.61 ± 2.23 were further analyzed for FIB-4 score and referral patterns. 316 patients had active EAU and a high FIB-4, of whom only 116 (37%) were referred to hepatology. Patients with alcohol-related mental health concerns and admitted for trauma were less likely to be referred. Logistic regression showed referral was higher with alcohol-related liver hospitalizations (OR: 9.25, 95% CI: 4.90-17.47, p < 0.001), higher CCI (OR: 6.23, 95% CI: 3.00-12.94, p < 0.0001) and lower with mental health admissions (OR: 0.36, 95% CI: 0.15-0.48, p < 0.001) or mental health diagnoses (OR: 0.36, 95% CI: 0.15-0.82, p = 0.02) and increasing age (OR: 0.95, 95% CI: 0.92-0.97, p < 0.001).
In a large public health system, almost 63% of patients with EAU and FIB-4 >2.67 are not referred to hepatology for evaluation. Patients not referred were more likely to have alcohol-related mental-health hospitalizations and mental health diagnoses, while those with liver-related hospitalizations and comorbidities were more likely to be referred. Greater education of mental health providers and for teams taking care of inpatients admitted with alcohol-related mental health concerns would better integrate care and improve outcomes for patients with higher risk for advanced liver disease.
酒精使用障碍（AUD）是一种多方面的疾病，将AUD治疗在精神卫生和肝病学之间进行整合对于改善治疗效果是必要的。我们旨在确定那些有过量饮酒（EAU）且FIB-4升高（这是一种识别晚期肝病的非侵入性方法）的患者是否被适当地转诊至肝病科，并检测可能存在的临床障碍（如果有的话）。
从一个大型公共系统中提取2013年至2023年间过量饮酒患者的记录。评估人口统计学、与酒精相关的住院情况、精神健康状况、查尔森合并症指数（CCI）和转诊模式。对转诊至肝病科的患者与未转诊的患者进行比较。
1131名受试者有EAU的证据，但进一步审查后，189人处于戒酒状态。其余942名（636名男性，年龄55.7±14.5岁，548名白人，363名黑人，19名西班牙裔）CCI为2.61±2.23的受试者进一步分析FIB-4评分和转诊模式。316名患者有活动性EAU且FIB-4升高，其中只有116名（37%）被转诊至肝病科。有酒精相关精神健康问题且因创伤入院的患者被转诊的可能性较小。逻辑回归显示，与酒精相关的肝病住院患者转诊率更高（比值比：9.25，95%置信区间：4.90-17.47，p<0.001），CCI越高转诊率越高（比值比：6.23，95%置信区间：3.00-12.94，p<0.0001），而精神科住院患者（比值比：0.36，95%置信区间：0.15-0.48，p<0.001）或精神科诊断患者（比值比：0.36，95%置信区间：0.15-0.82，p=0.02）以及年龄增加（比值比：0.95，95%置信区间：0.92-0.97，p<0.001）时转诊率较低。
在一个大型公共卫生系统中，几乎63%的EAU且FIB-4>2.67的患者未被转诊至肝病科进行评估。未被转诊的患者更有可能有与酒精相关的精神科住院和精神科诊断，而有肝病相关住院和合并症的患者更有可能被转诊。对精神卫生提供者以及照顾有酒精相关精神健康问题住院患者的团队进行更多教育，将更好地整合护理并改善晚期肝病高风险患者的治疗效果。
