Impact of Alcohol Use Disorder Treatment on Clinical Outcomes Among Patients With Cirrhosis.
Impact of Alcohol Use Disorder Treatment on Clinical Outcomes Among Patients With Cirrhosis.
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DOI：
10.1002/hep.31042
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发表时间：
2020-06
期刊：
影响因子：
--
通讯作者：
Kraemer KL
中科院分区：
文献类型：
--
作者：
Rogal S;Youk A;Zhang H;Gellad WF;Fine MJ;Good CB;Chartier M;DiMartini A;Morgan T;Bataller R;Kraemer KL
尽管肝硬化患者中共存酒精使用障碍（AUD）的显著医疗和经济后果，但对AUD治疗模式及其对该人群临床结局的影响知之甚少。我们的目的是描述AUD治疗肝硬化患者的使用和结局。这项回顾性队列研究包括接受退伍军人健康管理局（VA）护理并在2011年至2015年期间诊断为AUD的肝硬化退伍军人。我们评估了与AUD治疗（药物治疗或行为治疗）相关的基线因素和研究时间范围内首个AUD诊断代码后180天的临床结局。在93，612名患有肝硬化的退伍军人中，我们确定了35，682名患有AUD，排除了2，671名先前诊断为AUD和最近治疗的人。在指标诊断为AUD后的180天内，5，088例（14%）接受了AUD治疗，其中4，461例（12%）仅接受行为治疗，159例（0.4%）仅接受药物治疗，468例（1%）同时接受行为和药物治疗。在校正分析中，基于行为和/或药物治疗的AUD治疗与肝失代偿事件的显著减少相关（6.5% vs. 11.6%，校正比值比[AOR]=0.63，95%置信区间[CI]=0.52-0.76），短期全因死亡率无显著降低（2.6% vs. 3.9%，AOR=0.79，95% CI=0.57-1.08），长期全因死亡率显著降低（51% vs. 58%，AOR=0.87，95% CI=0.80，0.96）。大多数肝硬化合并AUD患者在6个月随访期间未接受AUD行为或药物治疗。肝失代偿和死亡率的降低表明，未来的研究应重点关注对合并AUD和肝硬化的患者提供循证AUD治疗。
Despite significant medical and economic consequences of coexisting alcohol use disorder (AUD) in patients with cirrhosis, little is known about AUD treatment patterns and their impact on clinical outcomes in this population. We aimed to characterize the use of and outcomes associated with AUD treatment in patients with cirrhosis. This retrospective cohort study included Veterans with cirrhosis who received Veterans Health Administration (VA) care and had an index diagnosis of AUD between 2011 and 2015. We assessed the baseline factors associated with AUD treatment (pharmacotherapy or behavioral therapy) and clinical outcomes for 180 days following the first AUD diagnosis code within the study time frame. Among 93,612 Veterans with cirrhosis, we identified 35,682 with AUD, after excluding 2,671 who had prior diagnoses of AUD and recent treatment. Over 180 days following the index diagnosis of AUD, 5,088 (14%) received AUD treatment, including 4,461 (12%) who received behavioral therapy alone, 159 (0.4%) who received pharmacotherapy alone, and 468 (1%) who received both behavioral and pharmacotherapy. In adjusted analyses, behavioral and/or pharmacotherapy-based AUD treatment was associated with a significant reduction in incident hepatic decompensation (6.5% vs. 11.6%, adjusted odds ratio [AOR]=0.63, 95% confidence interval [CI]=0.52–0.76) and a non-significant decrease in short-term all-cause mortality (2.6% vs. 3.9%, AOR=0.79, 95% CI=0.57–1.08), and a significant decrease in long-term all-cause mortality (51% vs. 58%, AOR=0.87, 95% CI=0.80, 0.96). Most patients with cirrhosis and coexisting AUD did not receive behavioral or pharmacotherapy treatment for AUD over a 6-month follow-up. The reductions in hepatic decompensation and mortality suggest that future studies should focus on delivering evidence-based AUD treatments to patients with coexisting AUD and cirrhosis.
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影响因子：
3.7
作者：
Harris AH;Bowe T;Hagedorn H;Nevedal A;Finlay AK;Gidwani R;Rosen C;Kay C;Christopher M
通讯作者：
Christopher M
DOI：
10.15288/jsa.1997.58.365
发表时间：
1997-07-01
期刊：
JOURNAL OF STUDIES ON ALCOHOL
影响因子：
--
作者：
Grant, BF
通讯作者：
Grant, BF
影响因子：
6
作者：
Hauser, Peter;Fuller, Bret;Dieperink, Eric
通讯作者：
Dieperink, Eric
2001-2013 年美国退伍军人肝硬化和肝细胞癌负担趋势（按肝脏疾病分类
影响因子：
29.4
作者：
Beste, Lauren A.;Leipertz, Steven L.;Ioannou, George N.
通讯作者：
Ioannou, George N.
影响因子：
12.6
作者：
Ho, Samuel B.;Braeu, Norbert;Groesslk, Erik J.
通讯作者：
Groesslk, Erik J.