Unrecognized alcoholic hepatitis linked to higher mortality, hospitalization
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SAN DIEGO — A significant proportion of alcoholic hepatitis cases remain unrecognized and correlate with higher 30-day mortality, hospital length of stay and ICU admission, according to results presented at Digestive Disease Week 2022.
“Whether this increased mortality is from being left untreated vs. decreased tendency in that group to seek medical care (presence of other comorbidities) remains to be determined,” Julton Tomanguillo Chumbe, MD, of the division of gastroenterology at Charleston Area Medical Center in West Virginia, and colleagues wrote.
Aiming to compare and assess 30-day mortality, hospital length of stay and ICU admission between patients with confirmed vs. unrecognized alcoholic hepatitis (AH), Chumbe and colleagues identified 9,985 adults, aged 18 to 90 years, using the TriNetX database from January 2009 to October 2021. Of these, 1,982 patients had confirmed AH and 8,003 had unrecognized AH. The group of unrecognized AH patients included those who met the AASLD definition of probable AH but did not have the International Classification of Diseases diagnosis during hospitalization.
Investigators compared all-cause mortality between propensity-matched pairs of patients in both groups, as well as ICU admission and length of hospital stay.
Results showed those with confirmed AH had lower prevalence of key comorbidities compared with those with unrecognized AH, including diabetes (6.2% vs. 12.1%, P < 0.001), smoking (3.4% vs. 11.6%, P < 0.001), chronic heart failure (3% vs. 8.2%, P < 0.001), coronary artery disease (3% vs. 7%, P < 0.001), chronic obstructive pulmonary disease (2.2% vs. 7.5%, P < 0.001) and history of stroke (0.8% vs. 1.6%, P < 0.001).
Patients with confirmed AH also had lower mortality overall (2.4% vs. 22.1%, P < 0.001), which was verified with a Kaplan Meier estimator at 30 days.
Further, patients with confirmed AH had lower ICU admission compared with those with unrecognized AH (1.4% vs. 17.3%, P < 0.001), as well as decreased hospital length of stay (1 day vs. 5 days, P < 0.001).
These results, “highlight the need for more effort to be made towards identifying this patient population,” Chumbe and colleagues concluded.
Perspective
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Jamile’ Wakim-Fleming, MD, FACG, FAASLD
Alcohol consumption is part of the questionnaire during a primary care visit or admission to the hospital, especially when abnormal liver tests are present. In that case, alcoholic hepatitis (AH) is on the differential, and the diagnosis is usually strongly suggested when there is a history of alcohol consumption. However, the diagnosis may be missed for reasons not always clarified, and it is not clear whether these individuals have the same outcome, if they are known to have AH or not.
The study by Chumbe and colleagues attempts to answer this question, based on a retrospective review of charts of patients with the diagnosis of AH vs. probable AH. The latter was not coded as such and thus interpreted as unrecognized.
Results showed that those unrecognized for AH were more likely to be admitted to ICU, have a longer hospital stay and worse mortality.
These results are important. They alert clinicians to attempt to confirm the diagnosis of AH by using available diagnostic tools to document alcohol intake, such as EtG and PEth testing, in addition to conferring with the family, primary caregivers and, when stable, with the patient. A liver biopsy also may be necessary.
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Chumbe JT, et al. Poster Mo1321. Presented at: Digestive Disease Week; May 21-24, 2022; San Diego (hybrid meeting).
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