Associations Between Alcohol Use and Liver-Related Outcomes in a Large National Cohort of Patients With Cirrhosis.
Associations Between Alcohol Use and Liver-Related Outcomes in a Large National Cohort of Patients With Cirrhosis.
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DOI：
10.1002/hep4.1776
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发表时间：
2021-12
影响因子：
5.1
通讯作者：
Ioannou GN
中科院分区：
文献类型：
--
作者：
Pearson MM;Kim NJ;Berry K;Moon AM;Su F;Vutien P;Green PK;Williams EC;Ioannou GN
饮酒可导致肝硬化患者发生肝坏死性炎症并加重门静脉高压。我们旨在根据肝硬化的病因评估饮酒程度与临床肝脏相关结局之间的关联。在这项回顾性队列分析中，确定了44349名患有酒精相关性肝病（ALD）、慢性丙型肝炎病毒（HCV）感染或非酒精性脂肪性肝病所致肝硬化的美国退伍军人，他们在2012年完成了酒精使用障碍识别测试消费问卷。根据该评分，饮酒水平被分为无、低水平或不健康。多变量Cox比例风险回归用于评估饮酒与死亡率、肝硬化失代偿（新发腹水、肝性脑病或静脉曲张出血）以及肝细胞癌（HCC）之间的关联。在基线时，36.4%的患者承认饮酒，17.1%有不健康饮酒行为。在平均4.9年的随访期间，25806名（57.9%）患者死亡，9409名（21.4%）出现新的失代偿，4733名（11.1%）发生HCC。在ALD - 肝硬化和HCV - 肝硬化患者中，与不饮酒相比，不健康饮酒与更高的死亡风险（调整后的风险比[aHR]=1.13，95%置信区间[CI]=1.07 - 1.19和aHR = 1.14，95% CI = 1.08 - 1.20）以及失代偿风险（aHR = 1.18，95% CI = 1.07 - 1.30和aHR = 1.08，95% CI = 1.00 - 1.16）相关。无论肝硬化病因如何，饮酒与HCC均无关。结论：不健康饮酒在肝硬化患者中很常见，并且与HCV - 肝硬化和ALD - 肝硬化患者更高的死亡风险和肝硬化失代偿相关。因此，医疗服务提供者应尽一切努力帮助患者戒酒。饮酒与HCC之间缺乏关联值得进一步研究。
Alcohol use can cause hepatic necroinflammation and worsening portal hypertension in patients with cirrhosis. We aimed to evaluate the associations between degree of alcohol use and clinical liver‐related outcomes according to etiology of cirrhosis. In this retrospective cohort analysis, 44,349 U.S. veterans with cirrhosis from alcohol‐associated liver disease (ALD), chronic hepatitis C virus (HCV) infection, or nonalcoholic fatty liver disease were identified who completed the Alcohol Use Disorders Identification Test Consumption questionnaire in 2012. Based on this score, level of alcohol use was categorized as none, low level, or unhealthy. Multivariable Cox proportional hazards regression was used to assess for associations between alcohol use and mortality, cirrhosis decompensation (new ascites, encephalopathy, or variceal bleeding), and hepatocellular carcinoma (HCC). At baseline, 36.4% of patients endorsed alcohol use and 17.1% had unhealthy alcohol use. During a mean 4.9 years of follow‐up, 25,806 (57.9%) patients died, 9,409 (21.4%) developed a new decompensation, and 4,733 (11.1%) developed HCC. In patients with ALD‐cirrhosis and HCV‐cirrhosis, unhealthy alcohol use, compared with no alcohol use, was associated with higher risks of mortality (adjusted hazard ratio [aHR] = 1.13, 95% confidence interval [CI] = 1.07‐1.19 and aHR = 1.14, 95% CI = 1.08‐1.20, respectively) and decompensation (aHR = 1.18, 95% CI = 1.07‐1.30 and aHR = 1.08, 95% CI = 1.00‐1.16, respectively). Alcohol use was not associated with HCC, regardless of cirrhosis etiology. Conclusion: Unhealthy alcohol use was common in patients with cirrhosis and was associated with higher risks of mortality and cirrhosis decompensation in patients with HCV‐cirrhosis and ALD‐cirrhosis. Therefore, health care providers should make every effort to help patients achieve abstinence. The lack of association between alcohol use and HCC merits further investigation.
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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：
9.8
作者：
Serfaty, L;Poujol-Robert, A;Poupon, R
通讯作者：
Poupon, R
影响因子：
25.7
作者：
Alavi, Maryam;Janjua, Naveed Z.;Dore, Gregory J.
通讯作者：
Dore, Gregory J.
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：
25.7
作者：
Dunn, Winston;Sanyal, Arun J.;Brunt, Elizabeth M.;Unalp-Arida, Aynur;Donohue, Michael;McCullough, Arthur J.;Schwimmer, Jeffrey B.
通讯作者：
Schwimmer, Jeffrey B.