Women have 50% higher risk than men of progressing from alcoholic hepatitis to cirrhosis

About three in 10 young people who develop acute alcoholic hepatitis for the first time will develop cirrhosis within a median of four years, according to new data.¹

What’s more, there were significant differences in gender trends in this high-risk group: women were 47% more likely to develop cirrhosis than men.

In new findings from a study presented this weekend at the American Association for the Study of Liver Diseases (AASLD) 2023 Liver Meeting in Boston, a multinational expert panel reports that women ages 13 to 39 are significantly more likely to develop the disease. to their women. A male patient progressed from acute alcoholic hepatitis to cirrhosis after initial presentation. The findings also showed that patients who progressed to cirrhosis were older and reported multiple comorbidities compared with male patients.

Researchers led by Jennifer Flemming, MD, FRCPC, associate professor of medicine and public health sciences at Queen’s University, sought to assess the link between women and incident cirrhosis after first developing acute alcoholic hepatitis—a condition that is associated with chronic alcoholism versus chronic alcoholism. The trend of sexual hepatitis is increasing. Total alcohol-related liver disease in the United States.

Their retrospective, population-based cohort analysis included health care data from adolescents and young adults aged 13 to 39 years in Ontario, Canada, who first presented with acute alcoholic hepatitis in the emergency department or during hospitalization between 2002 and 2021. Until 2022, incident cirrhosis serves as the primary endpoint.

The team adjusted the sex-specific likelihood of progression to cirrhosis for age, income quintile, rural area, comorbidities, immigration status and disease severity (the last component was measured by emergency room or inpatient care).

Among the 3,340 adolescents and young adults who developed acute alcoholic hepatitis for the first time during the study period, the median patient age was 33 years; approximately one-third (36%) were female. Seven in 10 (70%) reported an alcohol-related medical experience within 2 years of developing acute alcoholic hepatitis. Another 70% required hospitalization and 19% had cirrhosis and/or decompensation.

Median length of stay was 5 days; 17% of admissions required intensive care unit admission; 2% required hemodialysis; 3% died before discharge.

Median follow-up was 4 years (interquartile range, 2 to 9); 22% of patients died during follow-up, and only 7 (<1%) required liver transplantation. Of the 2690 patients who were alive and without cirrhosis at 6 months after discharge, 29% were diagnosed with cirrhosis during follow-up. Among women with acute alcoholic hepatitis, 35% develop cirrhosis.

The adjusted risk of progression from acute alcoholic hepatitis to cirrhosis was 47% higher in women than in men (sHR, 1.47; 95% CI, 1.23 to 1.76; ask <.001). The researchers also observed that patients who progressed to cirrhosis were more likely to be older (sHR, 1.05; 95% CI, 1.03 to 1.06) and have a higher comorbidity count (sHR, 1.36; 95% CI, 1.01 to 1.82) Increase.

The cumulative incidence of death in patients with cirrhosis gradually increased at 1, 5, and 10 years, from 9% to 22%, and then to 31%, respectively.

In the second part of the interview HCP live During the liver meeting, Fleming discussed the impact of acute alcoholic hepatitis on young people, likening it to a “car accident” that accelerates patients into the late-stage burden of cirrhosis more quickly than other liver diseases.

“You don’t necessarily have underlying liver disease, but if someone who is predisposed drinks a lot of alcohol, all of a sudden it can cause very severe liver damage, and people can develop liver failure even if they don’t have liver disease. People from any background Cirrhosis of the liver,” Fleming said.

Although Fleming and colleagues observed higher rates of acute alcoholic hepatitis in younger patients, data on long-term outcomes beyond hospitalization are lacking. “If they survive that car accident, what happens to them in 5, 10, 15 years?” she continued.

Regarding the sex differences in outcomes, Fleming said the findings confirm what she and her colleagues have observed in the clinic—significant increases in female patients with acute and debilitating alcohol-related liver disease—and reinforce A call for growing gender-specific responses. The overall problem of acute alcoholic hepatitis.

“We also show that men and women with alcoholic hepatitis differ in their demographics and social determinants of health—they’re just different individuals,” Fleming said.

Regarding applicable solutions to the emerging crisis, Fleming pointed to public health policies around alcohol as well as general public education campaigns.

“The stereotype is that alcohol doesn’t affect women and doesn’t affect young people, but when you look at the data it’s hard to ignore that the average age of this group was 33 and within 5 years, 25% of them Some people died,” Fleming said. “I think this should be considered a public health crisis.”