Predictors of leaving against medical advice in patients with alcohol-related hepatitis

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Aalam Sohal1, Hunza Chaudhry1, Kanwal Bains2

  • 1Department of Internal Medicine, University of California, Fresno, California, USA (Aalam Sohal, Hunza Chaudhry, Sunny Sandhu).

Annals of Gastroenterology
|September 5, 2022
PubMed

Insights

Patients with alcohol-related hepatitis who leave against medical advice (LAMA) differ demographically. Younger, African American patients without insurance face the highest LAMA risk, informing targeted interventions for alcohol-related liver disease.

Area of Science:

  • Hepatology
  • Public Health
  • Health Services Research

Background:

  • Alcohol-related hepatitis is a severe form of alcohol-related liver disease with high morbidity and mortality.
  • Patients with alcohol use disorders are at risk of leaving against medical advice (LAMA).
  • Limited data exists on demographic factors and comorbidities associated with LAMA in this population.

Purpose of the Study:

  • To investigate demographic factors and comorbidities associated with leaving against medical advice (LAMA) in patients with alcohol-related hepatitis.
  • To identify patient subgroups at higher risk of LAMA.
  • To inform targeted interventions and improve patient education.

Main Methods:

  • Retrospective study of patients with alcohol-related hepatitis (ICD10-CM codes K70.4 and K70.1) from January 2016 to December 2019.
  • Analysis of demographics, comorbidities, complications, and interventions for patients who LAMA.
  • Multivariate analysis to determine factors contributing to LAMA risk.

Main Results:

  • Out of 538,750 patients admitted with alcohol-related hepatitis, 31,500 (5.84%) LAMA.
  • Younger age, African American race, lack of insurance, and lower income quartile were associated with the highest LAMA risk.
  • Older age, Hispanic race, private insurance, and higher income status were associated with a lower LAMA risk.

Conclusions:

  • Significant demographic differences exist between patients with alcohol-related hepatitis who LAMA and those who complete hospitalization.
  • Findings can help healthcare providers identify at-risk patients for LAMA.
  • Targeted education for specific subgroups may improve disease understanding and decrease adverse events.
Abstract

Keywords:
Alcohol-related liver diseaseNational Inpatient Samplealcoholic hepatitishepatitisleaving against medical advice

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