November 10, 2022
2 min read
Gougol A, et al. Clinical and laboratory scores can predict long-term cirrhosis in patients presenting with alcohol use disorder, longitudinal data from large health care network. Presented at: The Liver Meeting; Nov. 4-8, 2022; Washington (hybrid meeting).
Disclosures: Gougol reports no relevant financial disclosures.
WASHINGTON — Patients with alcohol use disorder and diabetes mellitus or hepatitis C were at higher risk for advanced liver disease, while African American race had a protective effect, according to late-breaking data at The Liver Meeting.
The prevalence of alcohol use disorder (AUD) in the U.S. is approximately 30 million, with 95,000 deaths per year and an annual cost of $250 billion, Amir Gougol, MD, a transplant hepatology fellow at the University of California, San Francisco, told attendees. It is the No. 1 indication for liver transplant in both the U.S. and Europe, with a progressive rise in incidence of alcoholic liver disease.
To determine the long-term incidence, clinical risk factors and lab parameters associated with the development of alcohol-related advanced liver disease (AALD) and subsequent mortality, Gougol and colleagues evaluated a historical cohort of 32,081 patients (mean age, 48.7 years; 65% men) with AUD between January 2006 and June 2017. They excluded patients with pre-existing AALD at the time of AUD diagnosis, as well as 4,454 patients with a fibrosis-4 score greater than 2.6.
After an average follow-up of 5.7 years, 10.2% of patients developed AALD and 18.3% died. While diabetes mellitus (HR = 1.6; 95% CI, 1.5-1.7) and hepatitis C (HR = 2.9; 95% CI, 2.7-3.2) were associated with a higher risk for AALD, African American race had a protective effect (HR = 0.75; 95% CI, 0.68-0.82).
According to researchers, these factors (diabetes, HCV, non-African American race) had an accumulative effect and were associated with a 50% risk for AALD. The absence of all three factors had an 8% risk for AALD over the follow-up period.
Further, fibrosis-4 index at the time of AUD presentation had moderate accuracy in predicting the 1-year risk for AALD (area under the curve = 0.62, specificity 86%, sensitivity 38%). Patients who had a fibrosis-4 index greater than 2.67 had a greater risk for developing AALD (HR = 3.1; 95% CI, 2.9-3.3) — this long-term risk increased by more than 3.7 times (95% CI, 3.4-4.1) among patients with a fibrosis-4 greater than 5 at baseline.
“There is a unique opportunity to identify, screen and monitor patients for long-term liver disease. We recommend using a 3-point score that should be available at any health care encounter to identify patients at risk,” Gougol concluded. “We recommend they screen for hep C and diabetes mellitus on any health care encounter for AUD.”