Short- and Long-Term Outcomes among a National Cohort of U.S. Veterans Hospitalized for Alcohol-Associated Hepatitis.

Abstract

Objective: Excessive alcohol use is highly prevalent among U.S. Veterans, contributing to alcohol-associated hepatitis (AH), a severe form of alcohol-associated liver disease (ALD). We evaluate longitudinal outcomes among a national cohort of U.S. Veterans hospitalized with AH.

Methods: U.S. Veterans hospitalized with AH from 2010 to 2023 were evaluated to determine rate of death during index hospitalization and at 28-days and 90-days following hospitalization. Adjusted Cox proportional hazards models evaluated for predictors of aforementioned outcomes. Additional analyses were performed among patients with severe AH with MELD > 20.

Results: 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 to non-Hispanic whites. Treatment with steroids was not associated significant difference in outcomes among patients with severe AH.

Conclusion: 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 ALD in this vulnerable population.