Alcohol Rehabilitation Within 3 Months after Alcohol Hepatitis and Survival - A National Analysis.

Alcohol use disorders Severe alcohol hepatitis alcohol abstinence mortality

Journal

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
ISSN: 1542-7714
Titre abrégé: Clin Gastroenterol Hepatol
Pays: United States
ID NLM: 101160775

Informations de publication

Date de publication:
27 Aug 2024
Historique:
received: 10 04 2024
revised: 24 07 2024
accepted: 26 07 2024
medline: 31 8 2024
pubmed: 31 8 2024
entrez: 29 8 2024
Statut: aheadofprint

Résumé

There is limited understanding of the benefits of alcohol rehabilitation after alcohol hepatitis (AH). We conducted a 2012-2021 national longitudinal study involving adult inpatients diagnosed with AH in France. We assessed the primary outcome of liver transplantation or death within one year after AH, including in its complicated form (CAH) defined as ≥ 2 hepatic or extrahepatic complications within 4 weeks after AH. The primary exposure was in-hospital alcohol rehabilitation within 3 months following AH. Patients who died (6.5%, n=5,282) or were censored (12.5%, n=10,180) ≤ 4 weeks after AH were excluded. We measured adjusted hazard ratios (aHR) and odds ratios (aOR) within the full cohort and propensity-matched samples. Among 65,737 patients (median age 52; IQR 44-60; 76% male), 12% died or underwent liver transplantation. In-hospital alcohol rehabilitation was noted for 25% of patients (15.2% among CAH patients) and was the primary discharge diagnosis for 13.3%. The one-year transplant-free survival rates were 94% (95% CI: 94% to 95%) for rehabilitated patients, compared to 85% (85% to 86%) for those without [aHR 0.62 (0.57 to 0.69) p < 0.001]. Among CAH patients, transplant-free survival was 78% (76% to 81%) with rehabilitation versus 70% (69% to 71%) without [aHR 0.82 (0.68 to 0.98) p = 0.025]. In propensity-matched samples, rehabilitation was linked to an aOR of 0.54 (0.49 to 0.55, p < 0.001) overall, and 0.73 (0.60 to 0.89, p = 0.002) among matched CAH patients. In-hospital alcohol rehabilitation within 3-months after AH and CAH improve transplant-free survival rate but remain underutilized. No external funding.

Sections du résumé

BACKGROUND AND AIMS OBJECTIVE
There is limited understanding of the benefits of alcohol rehabilitation after alcohol hepatitis (AH).
METHODS METHODS
We conducted a 2012-2021 national longitudinal study involving adult inpatients diagnosed with AH in France. We assessed the primary outcome of liver transplantation or death within one year after AH, including in its complicated form (CAH) defined as ≥ 2 hepatic or extrahepatic complications within 4 weeks after AH. The primary exposure was in-hospital alcohol rehabilitation within 3 months following AH. Patients who died (6.5%, n=5,282) or were censored (12.5%, n=10,180) ≤ 4 weeks after AH were excluded. We measured adjusted hazard ratios (aHR) and odds ratios (aOR) within the full cohort and propensity-matched samples.
RESULTS RESULTS
Among 65,737 patients (median age 52; IQR 44-60; 76% male), 12% died or underwent liver transplantation. In-hospital alcohol rehabilitation was noted for 25% of patients (15.2% among CAH patients) and was the primary discharge diagnosis for 13.3%. The one-year transplant-free survival rates were 94% (95% CI: 94% to 95%) for rehabilitated patients, compared to 85% (85% to 86%) for those without [aHR 0.62 (0.57 to 0.69) p < 0.001]. Among CAH patients, transplant-free survival was 78% (76% to 81%) with rehabilitation versus 70% (69% to 71%) without [aHR 0.82 (0.68 to 0.98) p = 0.025]. In propensity-matched samples, rehabilitation was linked to an aOR of 0.54 (0.49 to 0.55, p < 0.001) overall, and 0.73 (0.60 to 0.89, p = 0.002) among matched CAH patients.
CONCLUSIONS CONCLUSIONS
In-hospital alcohol rehabilitation within 3-months after AH and CAH improve transplant-free survival rate but remain underutilized.
FUNDING BACKGROUND
No external funding.

Identifiants

DOI: 10.1016/j.cgh.2024.07.037 PMID: 39209197
pubmed: 39209197
pii: S1542-3565(24)00775-4
doi: 10.1016/j.cgh.2024.07.037
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Investigateurs

Daniel Karinthi (D)
Juliette Nabarro (J)
Valérie D'halluin Venier (VD)
Anaïs Vallet Pichard (AV)

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.

Auteurs

Lucia Parlati (L)

AP-HP.Centre, Groupe Hospitalier Cochin Port Royal, DMU Cancérologie et spécialités médico-chirurgicales, Service de maladies du foie, Paris, France; Université Paris Cité, F-75006, Paris, France. Electronic address: lucia.parlati@aphp.fr.

Charlotte Mouliade (C)

AP-HP.Centre, Groupe Hospitalier Cochin Port Royal, DMU Cancérologie et spécialités médico-chirurgicales, Service de maladies du foie, Paris, France; Université Paris Cité, F-75006, Paris, France. Electronic address: charlotte.mouliade@aphp.fr.

Eric Nguyen Khac (E)

CHU Amiens, Hôpital sud, Service Hépato-Gastroentérologie, 1 rond point du Pr C. Cabrol, Amiens 80054 Cedex; Université de Picardie Jules Verne, Centre Universitaire de Recherche en Santé, INSERM UMR 1247, Groupe de Recherche sur l'Alcool & les Pharmacodépendances, Amiens, 80000, France. Electronic address: Nguyen-Khac.Eric@chu-amiens.fr.

Mathis Collier (M)

AP-HP.Centre, Groupe Hospitalier Cochin Port Royal, DMU Prime, Unité de Recherche clinique, Paris, France. Electronic address: mathis.collier@aphp.fr.

Stylianos Tzedakis (S)

Université Paris Cité, F-75006, Paris, France; AP-HP.Centre, Groupe Hospitalier Cochin Port Royal, DMU Cancérologie et spécialités médico-chirurgicales, Service de chirurgie digestive, Paris, France. Electronic address: stylianos.tzedakis@aphp.fr.

Samir Bouam (S)

AP-HP.Centre Université de Paris, Groupe Hospitalier Cochin Port Royal, DMU Prime, Service d'Information Médicale, Paris, France. Electronic address: samir.bouam@aphp.fr.

Anoisia Courtois (A)

AP-HP.Centre, Groupe Hospitalier Cochin Port Royal, DMU Cancérologie et spécialités médico-chirurgicales, Service de maladies du foie, Paris, France.

Marion Corouge (M)

Université de Picardie Jules Verne, Centre Universitaire de Recherche en Santé, INSERM UMR 1247, Groupe de Recherche sur l'Alcool & les Pharmacodépendances, Amiens, 80000, France.

Alexandre Louvet (A)

Service des maladies de l'appareil digestif, CHU Lille, Université de Lille and INSERM U995, Lille, France. Electronic address: alexandre.louvet@chu-lille.fr.

Stanislas Pol (S)

AP-HP.Centre, Groupe Hospitalier Cochin Port Royal, DMU Cancérologie et spécialités médico-chirurgicales, Service de maladies du foie, Paris, France; Université Paris Cité, F-75006, Paris, France. Electronic address: stanislas.pol@aphp.fr.

Philippe Sogni (P)

AP-HP.Centre, Groupe Hospitalier Cochin Port Royal, DMU Cancérologie et spécialités médico-chirurgicales, Service de maladies du foie, Paris, France; Université Paris Cité, F-75006, Paris, France. Electronic address: philippe.sogni@aphp.fr.

Amine Benyamina (A)

AP-HP.Sud, Hôpital Paul Brousse, Département de Psychiatrie et d'Addictologie, F-94800 Villejuif, France; Unité de recherche UR Psychiatrie-Comorbidités-Addictions PSYCOMADD Université Paris Saclay, Paris, France. Electronic address: amine.benyamina@aphp.fr.

Jürgen Rehm (J)

Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, M5S 2S1, Canada; Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, M5T 1R8, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, M5T 1R8, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, M5T 3M7, Canada; Institute of Medical Science (IMS), University of Toronto, Toronto, Ontario, M5S 1A8, Canada; Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany; Program on Substance Abuse & WHO CC, Public Health Agency of Catalonia, 81-95 Roc Boronat St., 8005, Barcelona, Spain. Electronic address: jtrehm@gmail.com.

Philippe Mathurin (P)

Service des maladies de l'appareil digestif, CHU Lille, Université de Lille and INSERM U995, Lille, France. Electronic address: philippe.mathurin@chu-lille.fr.

Vincent Mallet (V)

AP-HP.Centre, Groupe Hospitalier Cochin Port Royal, DMU Cancérologie et spécialités médico-chirurgicales, Service de maladies du foie, Paris, France; Université Paris Cité, F-75006, Paris, France. Electronic address: vincent.mallet@aphp.fr.

Classifications MeSH