Integrating addiction care in hepatology: Impact of liver consultation on post-discharge AUD treatment in alcohol-associated hepatitis.

BACKGROUND

Alcohol-associated hepatitis (AH) carries high short-term mortality and long-term morbidity. Current guidelines recommend that patients hospitalized with AH receive treatment for alcohol use disorder (AUD), including behavioral counseling and pharmacotherapy. However, integration of addiction treatment into routine inpatient care remains low. We evaluated whether inpatient hepatology consultation is associated with increased provision of AUD counseling and pharmacotherapy.

METHODS

We conducted a retrospective cohort study of adults hospitalized with AH between January 2020 and July 2024 at a single academic center. AH was defined by ICD-10 code and NIAAA criteria. The primary exposure was liver service consultation. Primary outcomes were AUD counseling (dichotomized as referral provided vs. not) and pharmacotherapy (prescription vs. none). Multivariable logistic and mixed effects regression modeling was used to assess associations.

RESULTS

There were 134 unique patients with 213 hospitalizations for AH. Median age was 47 years, 67% were male, and 73% were English-speaking. While nearly all patients (96%) received some form of counseling, only 17% were referred to structured rehabilitation programs and 30% received pharmacotherapy such as naltrexone, acamprosate, gabapentin and baclofen. In adjusted analyses, hepatology consultation (with or without GI involvement) was independently associated with higher odds of both referral to AUD treatment services (aOR 3.99, 95% CI 1.23-13.73 in a per-patient analysis and aOR 3.10, 95% CI 1.21-7.93 in a per-hospitalization analysis) and prescription of AUD pharmacotherapy (aOR 2.44, 95% CI 0.59-10.4 per-patient and aOR 3.74, 95% CI 1.16-12.06 per hospitalization).

CONCLUSIONS

Despite hospitalization being a critical opportunity to initiate evidence-based AUD care, most patients with AH did not receive guideline-concordant treatment. Liver consultation services were associated with improved pharmacotherapy delivery and AUD referrals. Embedding addiction treatment protocols within hepatology pathways may improve delivery of AUD care and reduce disparities in this high-risk population.