November 28, 2023
2 min read
Key points:
- In the 20-year study, women were more likely to develop cirrhosis than men.
- Female gender, older age, urban residence, and higher comorbidities were associated with the development of cirrhosis.
BOSTON — Female adolescents and young adults have a higher rate of liver-related mortality and a 50 percent higher risk of cirrhosis and decompensation after a first episode of alcoholic hepatitis, data show.
“Admissions to hospital for alcoholic hepatitis are increasing, with more adolescents and young adults hospitalized than other age groups, and recent data also suggest that rates of liver transplantation for alcoholic hepatitis are rising faster in this age group, ” Jennifer A. Flemming, MD, FRCPC, MAS, Associate Professor of Medicine and Public Health Sciences at Queen’s University told the liver conference. “Research also suggests that gender differences exist and that gender differences in alcohol susceptibility to liver injury and in alcohol use, participation, and alcohol use disorder treatment have also been observed.”
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“But there’s a lot we don’t know,” she continued.
In a retrospective population-based cohort study, Flemming and colleagues aimed to determine the contemporary epidemiology and demographics of adolescents and young adults with alcoholic hepatitis (AH), as well as gender, long-term mortality, and liver disease relationship between development. related complications.
Researchers identified 3,340 adolescents and young adults (median age 33 years; 64% male) in Ontario, Canada, who presented with AH for the first time but were diagnosed in the emergency department (n = 917) or in hospital (n = 2,423) Cirrhosis of the liver. 2002-2021. Of these, 2,374 were alive 6 months after discharge.
Within 2 years of the onset of AH, 71% had an alcohol-related health care experience, 57% had a history of mental illness, and 34% had a history of substance abuse. Analysis of the social determinants of health shows that 18% live in rural areas (22% women, 15% men), 32% belong to the lowest income quintile (37% vs. 30%), 13% are recent immigrants or refugees (7% vs. 16%), 23% are in the most ethnically diverse quintile (17% vs. 26%), and 30% are in the most housing unstable quintile (31% vs. 30%).
After a median follow-up of 5 years, 844 (25%) of the total population had died and less than 1% (n = 23) had received a liver transplant, which was more common in men. During the study period, liver-related mortality was more common among women than among men.
Among individuals who survived a first episode of AH without cirrhosis or decompensation, 31% developed cirrhosis after a median follow-up of 24 months (37% of women and 28% of men). Women were more likely to develop cirrhosis than men at all time points (5 years: 25% vs. 19%; 10 years: 32% vs. 24%; 15 years: 37% vs. 28%; 20 years: 37% vs. 30%), most of whom were diagnosed with cirrhosis within the first 5 years after first AH.
Additionally, competing risks analysis showed that women (subHR = 1.47; 95% CI, 1.23-1.76), older age (sHR = 1.04; 95% CI, 1.03-1.06), and urban residence (sHR = 1.29; 95% CI, 1.02 ) -1.65) and higher comorbidities (sHR = 1.36; 95% CI, 1.01-1.82) were associated with the development of cirrhosis.
“The incidence of alcoholic hepatitis is increasing among adolescents and young adults, with 25 percent dying after a median follow-up of 5 years,” Fleming said. “Younger people with alcoholic hepatitis are vulnerable to social determinants of health and gender differences, as well as underlying sociodemographic factors.”
She continued: “Although overall mortality after first presentation of alcoholic hepatitis is similar between sexes, women have higher liver-related mortality than men, and among those who survive alcoholic hepatitis, women have higher risk of cirrhosis and The risk of decompensation is 50% higher in men. “First presentation. “
Source/Disclosure
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Fleming JA et al. Among young people who survive an episode of alcoholic hepatitis, women have a 50% higher risk of cirrhosis and decompensation. Published in: Liver Meeting; November 10-14, 2023; Boston (Hybrid Meeting).
Disclosure: The Fleming Report has no relevant financial disclosures.
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