Atrial fibrillation in patients with alcohol-associated hepatitis leads to increased mortality.

Abstract

Background: Alcohol consumption is associated with increased risk for development of atrial fibrillation. Outcomes of patients with atrial fibrillation in the context of acute alcohol-associated hepatitis have yet to be investigated.

Methods: We performed a retrospective study of patients with alcohol-associated hepatitis from the National Inpatient Sample (2016-2019), comparing those with and without concurrent atrial fibrillation. Subgroup analysis with and without cirrhosis was alone performed. Statistical analysis performed using STATA 16.1 and multivariate logistic and linear regression.

Results: Among 475 600 patients with alcohol-associated hepatitis, 27 675 (5.8%) had atrial fibrillation. Patients with atrial fibrillation had a nearly two-fold increased in-hospital mortality (6.9%) compared with those without atrial fibrillation (3.9%) [adjusted odds ratio (OR) = 1.35, 95% confidence interval (CI) = 1.20-1.53] and higher odds of developing acute kidney injury (OR = 1.23, 95% CI = 1.15-1.32). They also had longer hospital stays and higher total hospital charges (7.5 vs. 6.0 days and $20 005 vs. $14 714, respectively). Among patients with alcohol-associated hepatitis and atrial fibrillation, 33% also had cirrhosis (n = 9190), and these patients had an even higher mortality rate (11.3%) than those with alcohol-associated hepatitis and atrial fibrillation alone (4.7%). Acute coronary syndrome, chronic kidney disease, and obesity were independently associated with increased mortality.

Conclusion: Patients with alcohol-associated hepatitis who have atrial fibrillation have an increased risk of in-hospital mortality and underlying cirrhosis compounds this risk. Early recognition of the effect of concomitant atrial fibrillation and alcohol-associated hepatitis could provide an opportunity for intervention.