Prognostic significance of prior alcohol use disorder in patients with presumed metabolic dysfunction-associated steatotic liver disease: A large multi-center cohort study.
Where this comes from
- Record sourced from PubMed, PMID 42528106.
- Also identified by DOI 10.1111/add.70567.
- No licence information is recorded for this record.
- Because redistribution is not established, this page shows the abstract only. Follow the links below for the full text.
Abstract
Alcohol use disorder (AUD) follows a chronic, relapsing course but is often overlooked when alcohol consumption is minimal at the time of evaluation. We aimed to assess the prognostic impact of a prior AUD diagnosis on liver-related outcomes in patients with presumed metabolic dysfunction-associated steatotic liver disease (MASLD). Retrospective cohort study utilizing 1:1 propensity score matching to balance demographics, comorbidities, and laboratory data. A multi-institutional network of 73 healthcare organizations in the United States, from January 2010 to January 2024. 82 472 adults with newly diagnosed MASLD, comprising 41 236 patients with a documented prior diagnosis of AUD and 41 236 matched controls without AUD. Patients with pre-existing liver disease (other than MASLD) or subsequent diagnoses of alcohol-associated liver disease were excluded. Incidence rates and hazard ratios (HRs) for cirrhosis, hepatic decompensation, hepatocellular carcinoma and the composite of liver transplantation or all-cause mortality. Over a median follow-up of 3 years, patients with prior AUD had statistically significantly higher risks of cirrhosis [HR = 1.38; 95% confidence interval (CI) = 1.20-1.59], hepatic decompensation (HR = 1.12; 95% CI = 1.01-1.24) and liver transplantation or mortality (HR = 1.39; 95% CI = 1.31-1.47) compared with non-AUD controls. This excess risk was attenuated among patients with high metabolic burden (≥3 cardiometabolic risk factors). Among patients with presumed metabolic dysfunction-associated steatotic liver disease (MASLD), a history of alcohol use disorder appears to be independently associated with adverse clinical outcomes, particularly in those with fewer metabolic risk factors. These findings highlight a missed clinical opportunity and support the integration of longitudinal alcohol assessments and behavioral interventions into the care of patients with presumed MASLD.