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Chronic and Heavy Drinking, Nutrition Status, and Progression of Liver Injury Negatively Affect the Mortality Risk in
Aishwarya Thakurdesai1,2, Anjali Kumari1,2, Henry Shay1,2
1Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville, Louisville, KY 40202, USA.
Insights
Alcohol-associated hepatitis (AH) progression and mortality are worsened by heavy alcohol consumption and poor nutrition. Routine assessment of alcohol intake and nutritional status can identify high-risk patients for improved AH treatment and outcomes.
Area of Science:
- Hepatology
- Gastroenterology
- Internal Medicine
Background:
- Alcohol-associated hepatitis (AH) is a severe form of alcohol-associated liver disease (ALD) with high mortality.
- Current survival prediction for AH primarily relies on static scores like the Age-Bilirubin-INR-Creatinine (ABIC) score.
- The influence of drinking patterns and nutritional status on AH progression and mortality requires further investigation.
Purpose of the Study:
- To evaluate the impact of alcohol drinking patterns and nutritional status on AH progression and mortality.
- To identify key factors influencing severity and survival in patients with AH.
Main Methods:
- Sixty-one adult AH patients were stratified by MELD score (non-severe vs. severe) and ABIC risk categories.
- Data collected included demographics, nutritional status (CONUT score), alcohol consumption (lifetime and recent), and clinical/laboratory measures.
- Statistical analyses correlated drinking patterns and nutritional status with AH severity and mortality predictors.
Main Results:
- A significant positive correlation was found between ABIC score and lifetime drinking history (LTDH) in all AH patients and severe AH.
- AST:ALT ratios, a marker of liver injury, were associated with LTDH, AUDIT score, and CONUT score, particularly in intermediate mortality risk patients.
- Severe AH showed rapid progression even with initially low mortality risk scores.
Conclusions:
- Chronic and recent heavy alcohol consumption, along with poor nutrition, significantly worsen AH severity and increase mortality risk.
- Integrating alcohol intake and nutritional assessments into routine clinical practice can help identify high-risk AH patients.
- Early identification and intervention based on alcohol consumption and nutritional status may improve treatment outcomes and prognosis for AH patients.
Abstract:
Background/Objectives: Alcohol-associated hepatitis (AH) is an acute inflammatory condition of alcohol-associated liver disease (ALD) with rapid progression and high mortality. The Age-Bilirubin-INR-Creatinine (ABIC) score is a static algorithm that predicts survivability in AH. The roles of alcohol drinking patterns and nutritional status in AH progression and risk of death are understudied. This study evaluates the impact of alcohol drinking patterns and nutrition on AH progression and mortality. Methods: Sixty-one adult patients diagnosed with AH were stratified by the Model for End-Stage Liver Disease (MELD) as non-severe (MELD < 20, n = 26, Gr.1) and severe (MELD ≥ 20, n = 35, Gr.2). Each group was further subdivided by ABIC: low- (<6.71), intermediate- (6.71-9), and high- (>9) risk categories. We assessed different demographics: nutrition using the Controlling Nutritional Status (CONUT) score; lifetime drinking history (LTDH); recent alcohol use (AUDIT); laboratory measures (complete metabolic panel, complete blood count, and coagulation), and clinical measures (Maddrey DF, Child-Turcotte-Pugh, and Lille). Results: All patients showed a significant and positive correlation between ABIC and LTDH (r = 0.538, p = 0.004), particularly in Gr.2 (r = 0.554, p = 0.011). The low-risk Gr.2 exhibited the highest AST:ALTs. AST:ALTs were significantly associated with LTDH, AUDIT, and CONUT (R2 = 0.539, p = 0.031). In all AH patients with intermediate mortality risk, AST:ALTs were strongly linked to CONUT and LTDH (R2 = 0.657, p = 0.017). Conclusions: Severe AH demonstrates rapid liver injury progression even when the mortality risk is low. Chronic and recent heavy alcohol consumption and poor nutrition adversely impact AH severity and mortality risk. Alcohol intake and nutritional assessments in routine clinicals could identify high-risk patients, thereby improving treatment and a favorable prognosis.
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