PDF | https://doi.org/10.46613/congastro2023-202
This work is licensed under CC BY 4.0
Díaz L1, Idalsoaga F1, Ayares G1, Arnold J1, Alcayaga B1, Maldonado K2, Ayala M3, Perez D3, Gomez J3, Escarate R3, Fuentes E1, Roblero J4, Simian D4, Norero B5, Lazarte R6, Velarde J7, Higuera-de-la-Tijera F8, Córdova J9, Varela J10, Mejía S11, Silva R12, Melo C13, Araujo R14, Pereira G15, Couto C16, Bessone F17, Tanno M17, Romero G18, Mendizabal M19, Marciano S20, Gomez G20, Dirchwolf M21, Montes P22, Guerra P23, Ramos G23, Restrepo J24, Carrera E25, Brahmania M26, Singal A27, Bataller R28, Shah V29, Kamath P29, Arrese M1, Arab J30
1Pontificia Universidad Católica de Chile, Santiago, Chile
2Roosevelt Hospital, Ciudad de Guatemala, Chile
3Hospital El Pino, Santiago, Chile
4Sección Gastroenterología, Santiago, Chile
5Hospital Dr. Sótero del Río, Santiago, Chile
6Clínica Hospital del Profesor, Santiago, Chile
7Hospital Civil Guadalajara, Guadalajara, México
8Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, México
9Hospital General Manuel Gea González, Mexico City, México
10Hospital Dublán, Chihuahua, México
11Hospital Juárez de México, Mexico City, México
12Hospital de Base da Faculdade de Medicina de São Jose do Rio Preto, Sao Paulo, Brasil
13Fhaj Fundação Hospital Adriano Jorge, Amazonas, Brasil
14Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brasil
15Hospital Federal de Bonsucesso, Rio de Janeiro, Brasil
16Hospital das Clinicas Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
17Hospital Provincial del Centenario, Santa Fe, Argentina
18Hospital de Gastroenterología ” Dr. Carlos Bonorino Udaondo”, Buenos Aires, Argentina
19Hospital Universitario Austral, Buenos Aires, Argentina
20Hospital Italiano Buenos Aires, Buenos Aires, Argentina
21Hospital Privado de Rosario, Rosario, Argentina
22Hospital Nacional Daniel Alcides Carrión – Callao, Bellavista, Perú
23Instituto Gastroenterológico Boliviano- Japonés, Cochabamba, Bolivia
24Universidad de Antioquia, Medellin, Colombia
25Hospital Especialidades Eugenio Espejo, Quito, Ecuador
26Univeristy of Calgary, Calgary, Canadá
27University of South Dakota Sanford School of Medicine, Sioux Falls, Estados Unidos (EEUU)
28Hospital Clinic, Barcelona, España
29Mayo Clinic, Rochester, Estados Unidos (EEUU)
30Western University, London Health Sciences Center, London, Canadá
Background: Concomitantsubstance use is frequent among patients with alcohol use disorder (AUD), but its impact on alcohol-associated hepatitis (AH) is unknown.
Aims: To assess the prevalence and impact of substance use in patients hospitalized for AH in a multinational cohort.
Methods: Multicenter prospective cohort study including patients with AH between 2015–2022. We assessed the impact of substance consumption using competing-risk models.
Results: We included 405 patients from 24 centers in 8 countries (Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Mexico, and Peru). The mean age was 49.6±12.2 years, 345 (85.4%) were men, 210 (57.5%) had underlying cirrhosis, and the median MELD at diagnosis was 25 [20–31] points. Around 74% of patients fulfilled ACLF criteria (ACLF-1:11.1%, ACLF-2:11.6%, ACLF-3:49.6%). A total of 82 (20.3%) reported active substance use, while 22 (5.4%) were former substance users. The most common drugs used were marijuana (11.1%), cocaine (10.4%), methamphetamine (4.4%), and heroin (0.5%). Out of the total, 35.7% died, and only 2.5% underwent liver transplantation during follow-up. Active substance use was higher in younger patients (users 44.4±16.1 years vs. non-users 51.0±10.6 years; p<0.001) and in men compared to women (22.0% vs 10.2%, p=0.036). In a competing-risk model adjusted by age, sex, history of cirrhosis, MELD, and ACLF, active substance use was independently associated with mortality (subdistribution Hazard Ratio [sHR] 1.53, 95%CI:1.01–2.32; p=0.043). Active cocaine (sHR 1.69, 95%CI:1.07–2.70; p=0.025) and marijuana use (sHR 1.83, 95%CI:1.11–3.04; p=0.018) were independently associated with mortality in adjusted competing-risk analyses.
Conclusions: Active drug use is common in AH patients. Marijuana and cocaine were the most frequent substances and were independently associated with increased mortality. Integrated management with addiction specialists and psychiatrists could impact survival in AH.