Ashwani K Singal1, Sumant Arora2, Robert J Wong3, Sanjaya K Satapathy4, Vijay H Shah5, Yong-Fang Kuo6, Patrick S Kamath5. 1. Division of Transplant Hepatology, Department of Medicine, University of South Dakota Sanford School of Medicine and Avera Transplant Institute, Sioux Falls, South Dakota, USA. 2. Division of Gastroenterology and Hepatology, University of Iowa Hospital & Clinics, Iowa City, Iowa, USA. 3. Division of Gastroenterology and Hepatology, Alameda Health System Highland Hospital, Oakland, California, USA. 4. Division of Hepatology, Sandra Atlas Bass Center for Liver Diseases, Northwell Health, Manhasset, New York, USA. 5. Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA. 6. Department of Biostatistics, University of Texas Medical Branch, Galveston, Texas, USA.
Abstract
OBJECTIVES: Alcohol-associated liver disease is increasing, especially hospitalizations with acute on chronic liver failure and need for liver transplant. We examined trends in prevalence, inhospital mortality, and resource utilization associated with AALD and ACLF in the young. METHODS: The National Inpatient Sample (2006-2014) was queried for hospitalizations with a discharge diagnosis of cirrhosis using the International Classification of Diseases, Ninth Edition, codes. ACLF hospitalization was defined as ≥2 organ failures and stratified by age: young (≤35 years) and older (>35 years). RESULTS: Of 447,090 AALD admissions (16,126 in young) between 2006 and 2014, ACLF occurred in 29,599 (6.6%), of which 1,143 (7.1%) were in young. Compared with older, admissions in young had more women (35% vs 29%), were obese (11% vs 7.6%), were Hispanics (29% vs 18%), have alcoholic hepatitis (AH) (41% vs 17%), and have ACLF grades 2 or 3 (34% vs 25%), P < 0.001 for all. Between 2006 and 2014, ACLF in AALD among young increased from 2.8% to 5.2%, with an AH proportion from 24% to 42%, P < 0.0001 for both. Young had more complications requiring ventilation (79% vs 76%) and dialysis (32% vs 28%), P < 0.001 for both. Compared with older, ACLF admission in young had longer hospitalization (12 vs 10 days) with higher hospital charges ($127,915 vs $97,511), P < 0.0001 for both, with 20% reduced inhospital mortality (54%-45%), P < 0.001. DISCUSSION: AALD-related hospitalizations are increasing in young in the United States, mainly because of the increasing frequency of AH. Furthermore, this disease burden in young is increasing with a higher frequency of admissions with more severe ACLF and consumption of hospital resources. Studies are needed to develop preventive strategies to reduce burden related to AALD and ACLF in young.
OBJECTIVES:Alcohol-associated liver disease is increasing, especially hospitalizations with acute on chronic liver failure and need for liver transplant. We examined trends in prevalence, inhospital mortality, and resource utilization associated with AALD and ACLF in the young. METHODS: The National Inpatient Sample (2006-2014) was queried for hospitalizations with a discharge diagnosis of cirrhosis using the International Classification of Diseases, Ninth Edition, codes. ACLF hospitalization was defined as ≥2 organ failures and stratified by age: young (≤35 years) and older (>35 years). RESULTS: Of 447,090 AALD admissions (16,126 in young) between 2006 and 2014, ACLF occurred in 29,599 (6.6%), of which 1,143 (7.1%) were in young. Compared with older, admissions in young had more women (35% vs 29%), were obese (11% vs 7.6%), were Hispanics (29% vs 18%), have alcoholic hepatitis (AH) (41% vs 17%), and have ACLF grades 2 or 3 (34% vs 25%), P < 0.001 for all. Between 2006 and 2014, ACLF in AALD among young increased from 2.8% to 5.2%, with an AH proportion from 24% to 42%, P < 0.0001 for both. Young had more complications requiring ventilation (79% vs 76%) and dialysis (32% vs 28%), P < 0.001 for both. Compared with older, ACLF admission in young had longer hospitalization (12 vs 10 days) with higher hospital charges ($127,915 vs $97,511), P < 0.0001 for both, with 20% reduced inhospital mortality (54%-45%), P < 0.001. DISCUSSION: AALD-related hospitalizations are increasing in young in the United States, mainly because of the increasing frequency of AH. Furthermore, this disease burden in young is increasing with a higher frequency of admissions with more severe ACLF and consumption of hospital resources. Studies are needed to develop preventive strategies to reduce burden related to AALD and ACLF in young.
Authors: Ashwani K Singal; Andrea DiMartini; Lorenzo Leggio; Juan P Arab; Yong-Fang Kuo; Vijay H Shah Journal: Alcohol Alcohol Date: 2022-09-10 Impact factor: 3.913
Authors: Ashwani K Singal; Paul Kwo; Allison Kwong; Suthat Liangpunsakul; Alexandre Louvet; Pranoti Mandrekar; Craig McClain; Jessica Mellinger; Gyongyi Szabo; Norah Terrault; Mark Thursz; Gerald S Winder; W Ray Kim; Vijay H Shah Journal: Hepatology Date: 2021-11-27 Impact factor: 17.298
Authors: D Morales-Arráez; M Ventura-Cots; J Altamirano; J G Abraldes; M Cruz-Lemini; M R Thursz; S R Atkinson; S K Sarin; W Kim; R Chavez-Araujo; M F Higuera-de la Tijera; A K Singal; V H Shah; P S Kamath; A Duarte-Rojo; E A Charles; V Vargas; M Jager; P E Rautou; D Rincon; F Zamarripa; J C Restrepo-Gutiérrez; A Torre; M R Lucey; J P Arab; P Mathurin; A Louvet; G García-Tsao; J A González; E C Verna; R S Brown; J Argemi; C Fernández-Carrillo; A Clemente; E Alvarado-Tapias; E Forrest; M Allison; R Bataller Journal: Am J Gastroenterol Date: 2022-02-01 Impact factor: 12.045
Authors: Muhammad Waleed; Mohamed A Abdallah; Yong-Fang Kuo; Juan P Arab; Robert Wong; Ashwani K Singal Journal: Front Physiol Date: 2020-12-03 Impact factor: 4.566