Alcohol treatment discussions and clinical outcomes among patients with alcohol-related cirrhosis.
Alcohol treatment discussions and clinical outcomes among patients with alcohol-related cirrhosis.
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DOI：
10.1186/s12876-023-02656-z
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发表时间：
2023-02-02
影响因子：
2.4
通讯作者：
Rogal, Shari S.
中科院分区：
文献类型：
--
作者：
Alexandre, Wheytnie;Muhammad, Haseeb;Agbalajobi, Olufunso;Zhang, Grace;Gmelin, Theresa;Adejumo, Adeyinka;Noll, Alan;Jonassaint, Naudia L.;DiMartini, Andrea;Bataller, Ramon;Rogal, Shari S.
戒酒是治疗酒精相关性肝硬化的基石。本研究评估了关于酒精使用障碍（AUD）治疗的医学对话、AUD治疗参与和死亡率之间的关系。这项回顾性队列研究纳入了2015年在单一医疗保健系统中从事肝病治疗的所有具有ICD-10肝硬化和AUD诊断代码的患者。评估基线人口统计学、医学、肝脏疾病和AUD治疗数据。收集AUD治疗讨论和开始、戒酒以及随后的5年死亡率。采用多变量模型评估与AUD后续治疗和5年死亡率相关的因素。在436例酒精所致肝硬化患者中，65例（15%）患者在基线时接受AUD治疗，其中48例（11%）单独接受行为治疗，11例（2%）单独接受药物治疗，6例（1%）同时接受两种治疗。在基线肝病就诊后的第一年，37名患者接受AUD治疗，51名患者继续治疗，14名患者停止治疗。30%的患者有肝病记录的AUD治疗建议，26%的患者有初级保健记录的AUD治疗建议。大多数肝病学（86%）和初级保健（88%）建议单独讨论行为治疗。在基线时持续饮酒的患者中，一年后的AUD治疗与肝病学（调整优势比（aOR）： 3.23, 95%可信区间（CI）： 1.58, 6.89）或初级保健（aOR: 2.95; 95% CI: 1.44, 6.15）的AUD治疗讨论显著独立相关，与医疗补助保险（aOR: 0.43, 95% CI: 0.18, 0.93）负相关。当在两种情况下讨论治疗时，高治愈率随之而来（aOR: 10.72, 95% CI: 3.89, 33.52）。在5年随访期间，152例（35%）患者死亡。在最终生存模型中，持续饮酒、年龄、肝失代偿和肝细胞癌与死亡率显著相关。在酒精相关性肝硬化患者的肝病学和初级保健就诊中，记录了不到一半的AUD治疗讨论，尽管此类讨论与AUD治疗的接受显著相关。
Alcohol cessation is the cornerstone of treatment for alcohol-related cirrhosis. This study evaluated associations between medical conversations about alcohol use disorder (AUD) treatment, AUD treatment engagement, and mortality. This retrospective cohort study included all patients with ICD-10 diagnosis codes for cirrhosis and AUD who were engaged in hepatology care in a single healthcare system in 2015. Baseline demographic, medical, liver disease, and AUD treatment data were assessed. AUD treatment discussions and initiation, alcohol cessation, and subsequent 5-year mortality were collected. Multivariable models were used to assess the factors associated with subsequent AUD treatment and 5-year mortality. Among 436 patients with cirrhosis due to alcohol, 65 patients (15%) received AUD treatment at baseline, including 48 (11%) receiving behavioral therapy alone, 11 (2%) receiving pharmacotherapy alone, and 6 (1%) receiving both. Over the first year after a baseline hepatology visit, 37 patients engaged in AUD treatment, 51 were retained in treatment, and 14 stopped treatment. Thirty percent of patients had hepatology-documented AUD treatment recommendations and 26% had primary care-documented AUD treatment recommendations. Most hepatology (86%) and primary care (88%) recommendations discussed behavioral therapy alone. Among patients with ongoing alcohol use at baseline, AUD treatment one year later was significantly, independently associated with AUD treatment discussions with hepatology (adjusted odds ratio (aOR): 3.23, 95% confidence interval (CI): 1.58, 6.89) or primary care (aOR: 2.95; 95% CI: 1.44, 6.15) and negatively associated with having Medicaid insurance (aOR: 0.43, 95% CI: 0.18, 0.93). When treatment was discussed in both settings, high rates of treatment ensued (aOR: 10.72, 95% CI: 3.89, 33.52). Over a 5-year follow-up period, 152 (35%) patients died. Ongoing alcohol use, age, hepatic decompensation, and hepatocellular carcinoma were significantly associated with mortality in the final survival model. AUD treatment discussions were documented in less than half of hepatology and primary care encounters in patients with alcohol-related cirrhosis, though such discussions were significantly associated with receipt of AUD treatment.
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影响因子：
3.9
作者：
Mellinger, Jessica L.;Winder, G. Scott;Blow, Frederic C.
通讯作者：
Blow, Frederic C.
影响因子：
6
作者：
Hauser, Peter;Fuller, Bret;Dieperink, Eric
通讯作者：
Dieperink, Eric
影响因子：
3.9
作者：
McCarty, Dennis;Gu, Yifan;McConnell, K. John
通讯作者：
McConnell, K. John
DOI：
10.1002/hep.31042
发表时间：
2020-06
期刊：
Hepatology (Baltimore, Md.)
影响因子：
--
作者：
Rogal S;Youk A;Zhang H;Gellad WF;Fine MJ;Good CB;Chartier M;DiMartini A;Morgan T;Bataller R;Kraemer KL
通讯作者：
Kraemer KL
影响因子：
25.8
作者：
Grant BF;Goldstein RB;Saha TD;Chou SP;Jung J;Zhang H;Pickering RP;Ruan WJ;Smith SM;Huang B;Hasin DS
通讯作者：
Hasin DS