Exploring the interaction between metabolic dysfunction and alcohol-associated hepatitis: A global study.
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Cari Vania, Perez María I, Tellez Ignacio, Idalsoaga Francisco, Valsan Arun, Nair Gowripriya, Soni Kriti, Rhoads S Fisher, Arnold Jorge, Ayala-Valverde Maria, Ramirez-Cadiz Carolina, Jalal Prasun K, Ibrahim Mohamad A, Elfeki Mohamed A, Roblero Juan P, Simian Daniela, Velarde-Ruiz Velasco Jose A, Cordova Jacqueline, Higuera-de-la-Tijera Fátima, Silva Rita, Rocha Cristina M, Araujo Roberta C, Fontani Guilherme M, Pereira Gustavo H, Bessone Fernando, Tanno Mario, Kisch Ayelen, Mendizabal Manuel, Marciano Sebastian, Gomez-Perdiguero Gonzalo, Montes Pedro, Guerra Salazar Patricia, Ramos Geraldine, Chacko Kristina R, Skladaný Lubomir, Maiwall Rakhi, Simonetto Douglas, Sanyal Arun J, Shah Vijay H, Singal Ashwani K, Dunn Winston, Kamath Patrick S, Loomba Rohit, Arrese Marco, Bataller Ramon, Díaz Luis A, Arab Juan P
Аннотация
APPROACH AND RESULTS: Multinational prospective cohort study (2015-2024) including hospitalized patients with AH across 32 centers in 14 countries. Diagnosis of AH was made using the National Institute on Alcohol Abuse and Alcoholism criteria. Analyses included adjusted competing-risk models by age, sex, ethnicity, history of cirrhosis, CMRF, corticosteroid use, MELD, and acute-on-chronic liver failure grade, with liver transplantation as a competing risk. Nine hundred thirty-six participants were included; the mean age was 48±11.2 years, and 88.9% were male. At least 1 CMRF was present in 46.6%; median body mass index was 24.2 kg/m 2 [IQR: 22.8-28.2], prevalence of diabetes 17.6%, hypertension 16.5%, and dyslipidemia 5.8%. Median MELD was 24.4 (19.3-31.4), 86.7% had severe AH, and 180-day survival was 72.9%. Survival did not differ by CMRF status (log-rank p =0.453). In adjusted competing-risk models, higher age (subdistribution hazard ratio [sHR] 1.03; 95% CI: 1.01-1.04), greater alcohol intake (per g/day; sHR: 1.001; 95% CI: 1.000-1.002), MELD (sHR: 1.04; 95% CI: 1.01-1.06), and acute-on-chronic liver failure grade 2-3 (sHR: 2.34 and 4.34) predicted mortality. However, no individual CMRF independently increased mortality. A prespecified nonlinear body mass index analysis showed modestly lower mortality between 25 and 40 kg/m², with a higher risk above 40 kg/m².
CONCLUSIONS: Among patients with severe AH, metabolic dysfunction was not associated with increased mortality. Although a higher body mass index was associated with slightly lower mortality in AH, this may reflect better nutritional status rather than a true protective effect.