Alcohol use disorder treatment and outcomes among hospitalized adults with alcoholic hepatitis

Adam C Winters; Folasade P May; Yun Wang; Paul Shao; Liu Yang; Arpan A Patel

doi:10.1016/j.dadr.2021.100004

Alcohol use disorder treatment and outcomes among hospitalized adults with alcoholic hepatitis

Drug Alcohol Depend Rep. 2021 Nov 17:1:100004. doi: 10.1016/j.dadr.2021.100004. eCollection 2021 Dec.

Authors

Adam C Winters¹, Folasade P May^{1

2

3}, Yun Wang¹, Paul Shao³, Liu Yang¹, Arpan A Patel^{1

2}

Affiliations

¹ Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
² Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA.
³ Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.

Abstract

Purpose: : The burden of alcohol-associated liver disease (ALD) in the United States (US) has continued to worsen in the background of rising rates of alcohol use disorder. Patients with ALD present to care at a late stage, often with the sequela of liver decompensation, such as gastrointestinal bleeding and infection. ALD is now the leading indication for liver transplantation. We aimed to measure the quality of care delivered to hospitalized patients with alcoholic hepatitis (AH) across 3 domains: 1) alcohol-use disorder (AUD) care, 2) inpatient cirrhosis care, and 3) alcohol-associated liver disease (ALD) care-and observe associations between quality of care and outcomes.

Methods: : We included hospital encounters between January 1, 2016 and January 1, 2019 to a large, diverse integrated health system for AH with active alcohol use within the prior 60 days. The diagnosis of AH was determined based on previously published clinical and laboratory criteria. Quality indicator (QI) pass rates were calculated as the proportion of patients eligible for each indicator who received the QI within the timeframe specified. We then evaluated the association between the receipt of all QIs and 6-month mortality, as well as AUD-specific QIs and 30-day readmission.

Results: : Of the 179 patients, the median age was 47 years-old, 59.2% were male and 49.2% were non-Hispanic White. The median Model for End-Stage Liver Disease-Sodium score was 25, while the median discriminant function was 33. Patients were followed for an average of 21 months. Overall, 14% of patients died during the index hospitalization while 17.3% died following discharge and 24.8% were re-admitted within 30-days. QI pass-rates were variable across the different domains. Few patients received AUD care-pass rates for receipt of pharmacotherapy and behavioral therapy at 6 months were only 19.1% and 35.1%, respectively. There was a significant association between receiving behavioral therapy and 6-month mortality-3% vs 18%, p = 0.05.

Conclusion: : The quality of care received during hospital encounters for AH is variable, and AUD-specific therapy is low. Future quality of care initiatives are warranted to link patients to AUD treatment to ensure optimal care and maximize patients survival in this at-risk population.

Keywords: Alcohol-associated liver disease; Alcohol-use disorder; Alcoholic hepatitis.