Liver, Cardiovascular and Infectious Outcomes in Alcohol-Associated Liver Disease With Cardiometabolic Risk Factors

Area of Science:

• Hepatology
• Cardiology
• Infectious Diseases

Background:

• Cardiometabolic risk factors (CMRF) are prevalent in alcohol-associated liver disease (ALD).
• The clinical impact of CMRF on ALD patient outcomes remains unclear.
• This study investigates if CMRF defines a higher-risk ALD phenotype.

Purpose of the Study:

• To evaluate if cardiometabolic risk factors (CMRF) identify a higher-risk phenotype among adults with alcohol-associated liver disease (ALD).

Main Methods:

• Multicenter retrospective cohort study using the TriNetX research network (2010-2019).
• Defined CMRF by overweight/obesity, dysglycemia, hypertension, or dyslipidemia.
• 1:1 propensity score matching (PSM) compared ALD patients with and without CMRF, stratified by cirrhosis.

Main Results:

• Five-year all-cause mortality was similar between ALD patients with and without CMRF.
• ALD patients with CMRF showed higher risks of alcohol-associated hepatitis and major adverse liver outcomes.
• Markedly increased cardiovascular complications (MACE, arrhythmia, heart failure) and infectious events were observed in ALD patients with CMRF.

Conclusions:

• Cardiometabolic risk factors (CMRF) do not increase short- to intermediate-term mortality in alcohol-associated liver disease (ALD).
• CMRF identifies an ALD phenotype with significantly higher liver, cardiovascular, and infectious morbidity.
• Systematic detection and management of CMRF are recommended for ALD care pathways.