Ashwani K Singal1,2, Arshad Arsalan1, Winston Dunn3, Juan P Arab4, Robert J Wong5, Yong-Fang Kuo6, Patrick S Kamath7, Vijay H Shah7. 1. Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA. 2. Division of Gastroenterology and Hepatology, Avera Transplant Institute, Sioux Falls, SD, USA. 3. Division of Gastroenterology and Hepatology, Kansas University Medical Center, Kansas City, KS, USA. 4. Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. 5. Division of Gastroenterology and Hepatology, Palo Alto VA Medical Center, Stanford University, Stanford, CA, USA. 6. Department of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA. 7. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Abstract
BACKGROUND: Alcohol use and alcohol-associated liver disease (ALD) burden are increasing in young individuals. AIM: To assess host factors associated with this burden. METHODS: National Health and Nutrition Examination Survey (NHANES), National Inpatient Sample (NIS), and United Network for Organ Sharing (UNOS) databases (2006-2016) were used to identify individuals with harmful alcohol use, ALD-related admissions, and ALD-related LT listings respectively. RESULTS: Of 15 981 subjects in NHANES database, weighted prevalence of harmful alcohol use was 17.7%, 29.3% in <35 years (G1) versus 16.9% in 35-64 years (G2) versus 5.1% in ≥65 years (G3). Alcohol use was about 11 and 4.7 folds higher in G1 and G2 versus G3, respectively. Male gender and Hispanic race associated with harmful alcohol use. Of 593 600 ALD admissions (5%, 77%, and 18% in G1-G3 respectively), acute on chronic liver failure (ACLF) occurred in 7.2%, (7.2 in G2 vs 6.7% in G1 and G3, P < 0.001). After controlling for other variables, ACLF development among ALD hospitalizations was higher by 14% and 10% in G1 and G2 versus G3, respectively. Female gender and Hispanic race were associated with increased ACLF risk by 8% and 17% respectively. Of 20,245 ALD LT listings (3.4%, 84.4%, and 12.2% in G1-G3 respectively), ACLF occurred in 28% candidates. Risk of severe (grade 2 or 3) ACLF was higher by about 1.7 fold in G1, 1.5 fold in females and 20% in Hispanics. CONCLUSION: Young age, female gender, and Hispanic race are independently associated with ALD-related burden and ACLF in the United States. If these findings are validated in prospective studies, strategies will be needed to reduce alcohol use in high risk individuals to reduce burden from ALD.
BACKGROUND:Alcohol use and alcohol-associated liver disease (ALD) burden are increasing in young individuals. AIM: To assess host factors associated with this burden. METHODS: National Health and Nutrition Examination Survey (NHANES), National Inpatient Sample (NIS), and United Network for Organ Sharing (UNOS) databases (2006-2016) were used to identify individuals with harmful alcohol use, ALD-related admissions, and ALD-related LT listings respectively. RESULTS: Of 15 981 subjects in NHANES database, weighted prevalence of harmful alcohol use was 17.7%, 29.3% in <35 years (G1) versus 16.9% in 35-64 years (G2) versus 5.1% in ≥65 years (G3). Alcohol use was about 11 and 4.7 folds higher in G1 and G2 versus G3, respectively. Male gender and Hispanic race associated with harmful alcohol use. Of 593 600 ALD admissions (5%, 77%, and 18% in G1-G3 respectively), acute on chronic liver failure (ACLF) occurred in 7.2%, (7.2 in G2 vs 6.7% in G1 and G3, P < 0.001). After controlling for other variables, ACLF development among ALD hospitalizations was higher by 14% and 10% in G1 and G2 versus G3, respectively. Female gender and Hispanic race were associated with increased ACLF risk by 8% and 17% respectively. Of 20,245 ALD LT listings (3.4%, 84.4%, and 12.2% in G1-G3 respectively), ACLF occurred in 28% candidates. Risk of severe (grade 2 or 3) ACLF was higher by about 1.7 fold in G1, 1.5 fold in females and 20% in Hispanics. CONCLUSION: Young age, female gender, and Hispanic race are independently associated with ALD-related burden and ACLF in the United States. If these findings are validated in prospective studies, strategies will be needed to reduce alcohol use in high risk individuals to reduce burden from ALD.
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