Short-Term and Long-Term Outcomes Among a National Cohort of US Veterans Hospitalized for Alcohol-Associated Hepatitis.

Abstract

Excessive alcohol use is highly prevalent among US Veterans, contributing to alcohol-associated hepatitis (AH), a severe form of alcohol-associated liver disease. We evaluate longitudinal outcomes among a national cohort of US Veterans hospitalized with AH. US Veterans hospitalized with AH from 2010 to 2023 were evaluated to determine the rate of death during index hospitalization and at 28 days and 90 days after hospitalization. Adjusted Cox proportional hazards models evaluated for predictors of aforementioned outcomes. Additional analyses were performed among patients with severe AH with model for end-stage liver disease (MELD) >20. Among 1,560 unique adults hospitalized for AH (58.8% with MELD >20), 6.8% died during index hospitalization, 12.5% within 28 days, and 24.2% within 90 days. Among patients with severe AH with MELD>20, 10.3% died during index hospitalization, 19.2% within 28 days, and 34.9% within 90 days. Older age and increasing number of organ failures were associated with worse outcomes. Black/African Americans had lower risk of death compared with non-Hispanic whites. Treatment with steroids was not associated with significant difference in outcomes among patients with severe AH. Among a national cohort of hospitalized Veterans with AH, ∼25% of patients overall and over one-third with severe AH died within 90 days, respectively. These findings emphasize the importance of effective screening for unhealthy alcohol use and prompt linkage to alcohol treatment resources in Veterans to curb this rising epidemic of alcohol-associated liver disease in this vulnerable population.