Risk for cirrhosis 50% higher in young women after first episode of alcoholic hepatitis

Key takeaways:

• Women were more likely to develop cirrhosis compared with men during the 20-year study.
• Female sex, older age, urban residence and higher comorbidity were associated with development of cirrhosis.

BOSTON — Female adolescents and young adults have higher rates of liver-related mortality and a 50% higher risk for cirrhosis and decompensation after surviving their first presentation of alcoholic hepatitis, according to data.

“Hospital admissions for alcoholic hepatitis are increasing and more so in adolescents and young adults than in other age groups, and recent data has also suggested that rates for liver transplantation for alcoholic hepatitis are rising faster in this age group,” Jennifer A. Flemming, MD, FRCPC, MAS, associate professor of medicine and public health sciences at Queen’s University, said at The Liver Meeting. “It’s also been shown that sex differences exist, and the susceptibility to hepatic injury from alcohol and gender differences in alcohol use and engagement and alcohol use disorder treatment have also been observed.”

She continued: “But there are many things that we don’t know.”

In a retrospective, population-based cohort study, Flemming and colleagues aimed to define the contemporary epidemiology and demographics of adolescents and young adults with alcoholic hepatitis (AH), as well as the association between sex, long-term mortality and development of liver-related complications.

Researchers identified 3,340 adolescents and young adults (median age, 33 years; 64% men) in Ontario, Canada, with a first presentation of AH without cirrhosis diagnosed at an emergency department (n = 917) or inpatient admission (n = 2,423) from 2002 to 2021. Of those, 2,374 were alive 6 months after discharge.

Within 2 years of AH presentation, 71% had health care encounters related to alcohol, 57% had a history of mental illness and 34% had a history of substance abuse. Analysis of social determinants of health showed 18% lived in a rural area (22% women vs. 15% men), 32% were in the lowest income quintile (37% vs. 30%), 13% were recent immigrants or refugees (7% vs. 16%), 23% were in the highest ethnic diversity quintile (17% vs. 26%) and 30% were in the highest housing instability quintile (31% vs. 30%).

After a median follow-up of 5 years, 844 individuals (25%) in the total population died, and less than 1% (n = 23) underwent liver transplantation, which was more commonly performed in men. Over the study period, liver-related mortality was more common in women than men.

Among individuals who survived their first presentation of AH without cirrhosis or decompensation, 31% had developed cirrhosis (37% women vs. 28% men) after a median follow-up of 24 months. Across all time points, women were more likely to develop cirrhosis compared with men (5 years: 25% vs. 19%; 10 years: 32% vs. 24%; 15 years: 37% vs. 28%; and 20 years: 37% vs. 30%), the majority of whom were diagnosed with cirrhosis during the first 5 years after first AH presentation.

Further, competing risks analysis showed female sex (subHR = 1.47; 95% CI, 1.23-1.76), older age (sHR = 1.04; 95% CI, 1.03-1.06), urban residence (sHR = 1.29; 95% CI, 1.02-1.65) and higher comorbidity (sHR = 1.36; 95% CI, 1.01-1.82) were associated with development of cirrhosis.

“The incidence of alcoholic hepatitis is rising among adolescents and young adults, and death is occurring in 25% of these individuals after a median of 5 years of follow-up,” Flemming said. “The young alcoholic hepatitis population is vulnerable, and their social determinants of health and sex differences and underlying sociodemographic factors are present.”

She continued: “Although overall mortality after first presentation of alcoholic hepatitis is similar between sexes, females have higher rates of liver-related mortality than males, and female sex is associated with a 50% higher risk of cirrhosis and decompensation among those who survived their first presentation.”