A290 ILLICIT SUBSTANCE USE AND ITS IMPACT ON ALCOHOL-ASSOCIATED HEPATITIS IN LATIN AMERICA

Journal of the Canadian Association of Gastroenterology Pub Date : 2024-02-14 DOI:10.1093/jcag/gwad061.290

A H Islam, L. A. Diaz, F. Idalsoaga, G. Ayares, J. Arnold, B. Alcayaga, K. Maldonado, J. Arab

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Abstract

Abstract Background Concomitant substance use is frequent among patients with alcohol use disorder (AUD), but its impact on alcohol-associated hepatitis (AH) is unknown. Aims To assess the prevalence and impact of substance use in patients hospitalized for AH in a multinational cohort in Latin America. Methods Multicenter prospective cohort study including patients with AH between 2015-2022. We recorded sociodemographic and clinical information, including data on alcohol and drug use. We assessed the impact of substance consumption using competing-risk models. Results We included 405 patients from 24 centers in 8 countries (Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Mexico, and Peru). The mean age was 49.6±12.2 years, 345 (85.4%) were men, 210 (57.5%) had a previous diagnosis of cirrhosis, and the median MELD at diagnosis was 25 [20–31] points. Around 74% of patients fulfilled ACLF criteria (ACLF-1: 11.1%, ACLF-2: 11.6%, ACLF-3: 49.6%). A total of 82 (20.3%) reported active substance use, while 22 (5.4%) were former substance users. The most common drugs used at admission were marijuana (11.1%), cocaine (10.4%), methamphetamine (4.4%), and heroin (0.5%). Out of the total, 35.7% died, and only 2.5% underwent liver transplantation during follow-up. Active substance use was higher in younger patients (users 44.4±16.1 years vs. non-users 51.0±10.6 years; pampersand:003C0.001) and in men compared to women (22.0% vs 10.2%, p=0.036). In a competing-risk model adjusted by age, sex, history of cirrhosis, MELD, and ACLF grade, active substance use was independently associated with mortality (subdistribution Hazard Ratio [sHR] 1.53, 95%CI:1.01–2.32; p=0.043). Also, active cocaine (sHR 1.69, 95%CI:1.07–2.70; p=0.025) and marijuana use (sHR 1.83, 95%CI:1.11–3.04; p=0.018) were independently associated with mortality in adjusted competing-risk analyses. Conclusions Active drug use is common in AH patients. Marijuana and cocaine were the most frequent substances and were independently associated with increased mortality. Substance use should be screened in patients with AUD, and integrated management with addiction specialists and psychiatrists could impact survival in AH. Funding Agencies None

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A290 拉丁美洲非法药物使用及其对酒精相关肝炎的影响

摘要背景在酒精使用障碍（AUD）患者中，经常会同时使用药物，但其对酒精相关性肝炎（AH）的影响尚不清楚。目的评估拉丁美洲多国队列中因酒精相关性肝炎住院患者中药物使用的流行率及其影响。方法对 2015-2022 年间的 AH 患者进行多中心前瞻性队列研究。我们记录了社会人口学和临床信息，包括酒精和药物使用数据。我们使用竞争风险模型评估了药物消费的影响。结果我们纳入了来自 8 个国家（阿根廷、玻利维亚、巴西、智利、哥伦比亚、厄瓜多尔、墨西哥和秘鲁）24 个中心的 405 名患者。平均年龄为 49.6±12.2 岁，男性 345 人（85.4%），210 人（57.5%）既往诊断为肝硬化，诊断时的 MELD 中位数为 25 [20-31] 分。约 74% 的患者符合 ACLF 标准（ACLF-1：11.1%；ACLF-2：11.6%；ACLF-3：49.6%）。共有 82 名患者（20.3%）报告正在使用药物，22 名患者（5.4%）曾使用药物。入院时最常使用的毒品是大麻（11.1%）、可卡因（10.4%）、甲基苯丙胺（4.4%）和海洛因（0.5%）。其中，35.7%的患者死亡，只有2.5%的患者在随访期间接受了肝脏移植手术。较年轻患者（使用药物者为 44.4±16.1 岁，未使用药物者为 51.0±10.6 岁；pampersand:003C0.001）和男性患者（22.0%，10.2%，p=0.036）主动使用药物的比例高于女性患者。在按年龄、性别、肝硬化病史、MELD 和 ACLF 分级调整的竞争风险模型中，主动使用药物与死亡率独立相关（亚分布危险比 [sHR] 1.53，95%CI:1.01-2.32；p=0.043）。此外，在调整后的竞争风险分析中，主动使用可卡因（sHR 1.69，95%CI:1.07-2.70；p=0.025）和大麻（sHR 1.83，95%CI:1.11-3.04；p=0.018）也与死亡率独立相关。结论积极使用药物在 AH 患者中很常见。大麻和可卡因是最常见的药物，并且与死亡率的升高密切相关。应筛查 AUD 患者的药物使用情况，成瘾专科医生和精神科医生的综合管理可影响 AH 患者的存活率。资助机构无

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Journal of the Canadian Association of Gastroenterology

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