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Jain A, Wellner MR, Peng J, Ma J, Allen KD, McShane C, Ramsey ML, Mumtaz K, Kelly SG, Conteh LF, Kirkpatrick R, Sobotka LA. Impact of Social Vulnerability Index on Patients with Alcohol-Related Liver Disease. Alcohol 2024:S0741-8329(24)00116-2. [PMID: 39208955 DOI: 10.1016/j.alcohol.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/18/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Alcohol related liver disease (ALD) affects diverse communities with individual and social characteristics that can impact outcomes. The Social Vulnerability Index (SVI) assigns a score between 0 and 1, where higher scores represent an increased risk of social vulnerability. We sought to assess the impact of SVI on outcomes of patients hospitalized with ALD with access to social support services. METHODS AND MATERIALS Hospitalizations for ALD at our institution between March and August 2019 were reviewed. All patients were assigned an SVI score based on their residential census tract. Per our standard practice, patients were screened by care coordinators to identify needs for rehabilitation counseling, and care coordination after discharge. Demographics, hepatic decompensation, critical care needs, readmission, and mortality were compared. RESULTS Among 73 patients admitted for alcoholic hepatitis, 32 had a low SVI and 42 had a high SVI. African American patients were more likely to have a higher SVI (35% vs 0%, p=<0.001). No significant difference in outcomes based on SVI was noted. There were 393 patients admitted for alcoholic cirrhosis including 166 with a low SVI and 227 with a high SVI. Patients that were African American (23.6% vs 5.5%, p=<0.001) or disabled (41.4% vs 29.5%, p=0.008) had a higher SVI. No significant difference in outcomes based on SVI was noted. CONCLUSION Most patients admitted for ALD had a high SVI; however, SVI did not impact hospitalization outcomes.
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Affiliation(s)
- Ayushi Jain
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael R Wellner
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Jing Peng
- Department of Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Jianing Ma
- Department of Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Kenneth D Allen
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Chelsey McShane
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Mitchell L Ramsey
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Khalid Mumtaz
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Sean G Kelly
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Lanla F Conteh
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Robert Kirkpatrick
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Lindsay A Sobotka
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State Wexner Medical Center, Columbus, OH, USA.
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Kulkarni AV, Wall A, Reddy KR, Bittermann T. Early living donor liver transplantation for alcohol-associated hepatitis: Status in the era of increasing demand, unmet needs, and future considerations. Liver Transpl 2024:01445473-990000000-00426. [PMID: 39073609 DOI: 10.1097/lvt.0000000000000448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 07/23/2024] [Indexed: 07/30/2024]
Abstract
Hazardous alcohol consumption is the leading cause of liver disease worldwide. Alcohol-associated hepatitis (AH) is an acute and serious presentation of alcohol-associated liver disease that is associated with high short-term mortality. Medical management remains limited to corticosteroid therapy and intensive nutrition but improves survival in <50% of individuals. Liver transplantation (LT) is increasingly recognized as a treatment option for many patients with AH and may lead to greater survival benefits than medical management alone. The rate of waitlistings and LTs for AH has doubled in recent years, especially in the United States. Several studies from the West have reported early LT for AH to be successful, where deceased donor LT is the norm. The challenges of LT in living donor centers, particularly for those with AH, are unique and have previously not been discussed in depth. In this review, we aim to discuss the challenges unique to LDLT with respect to candidate and donor selection, ethical considerations, disparities in LDLT, post-LT alcohol relapse, and measures to prevent them while also addressing the definitions and outcomes of early-living donor liver LT for AH.
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Affiliation(s)
- Anand V Kulkarni
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Anji Wall
- Division of Abdominal Transplantation, Baylor University Medical Center, Dallas, Texas, USA
| | - K Rajender Reddy
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Therese Bittermann
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Allaudeen N, Akwe J, Arundel C, Boggan JC, Caldwell P, Cornia PB, Cyr J, Ehlers E, Elzweig J, Godwin P, Gordon KS, Guidry M, Gutierrez J, Heppe D, Hoegh M, Jagannath A, Kaboli P, Krug M, Laudate JD, Mitchell C, Pescetto M, Rodwin BA, Ronan M, Rose R, Shah MN, Smeraglio A, Trubitt M, Tuck M, Vargas J, Yarbrough P, Gunderson CG. Medications for alcohol-use disorder and follow-up after hospitalization for alcohol withdrawal: A multicenter study. J Hosp Med 2024. [PMID: 39031461 DOI: 10.1002/jhm.13458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND Alcohol withdrawal is a common reason for admission to acute care hospitals. Prescription of medications for alcohol-use disorder (AUD) and close outpatient follow-up are commonly recommended, but few studies report their effects on postdischarge outcomes. OBJECTIVES The objective of this study is to evaluate the effects of medications for AUD and follow-up appointments on readmission and abstinence. METHODS This retrospective cohort study evaluated veterans admitted for alcohol withdrawal to medical services at 19 Veteran Health Administration hospitals between October 1, 2018 and September 30, 2019. Factors associated with all-cause 30-day readmission and 6-month abstinence were examined using logistic regression. RESULTS Of the 594 patients included in this study, 296 (50.7%) were prescribed medications for AUD at discharge and 459 (78.5%) were discharged with follow-up appointments, including 251 (42.8%) with a substance-use clinic appointment, 191 (32.9%) with a substance-use program appointment, and 73 (12.5%) discharged to a residential program. All-cause 30-day readmission occurred for 150 patients (25.5%) and 103 (17.8%) remained abstinent at 6 months. Medications for AUD and outpatient discharge appointments were not associated with readmission or abstinence. Discharge to residential treatment program was associated with reduced 30-day readmission (adjusted odds ratio [AOR]: 0.39, 95% confidence interval [95% CI]: 0.18-0.82) and improved abstinence (AOR: 2.50, 95% CI: 1.33-4.73). CONCLUSIONS Readmission and return to heavy drinking are common for patients discharged for alcohol withdrawal. Medications for AUD were not associated with improved outcomes. The only intervention at the time of discharge that improved outcomes was discharge to residential treatment program, which was associated with decreased readmission and improved abstinence.
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Affiliation(s)
- Nazima Allaudeen
- Medical Service, VA Palo Alto Healthcare System, Palo Alto, California, USA
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Joyce Akwe
- Medical Service, Atlanta VA Medical Center, Atlanta, Georgia, USA
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Cherinne Arundel
- Medical Service, VA Washington DC Health Care System, Washington, District of Columbia, USA
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Joel C Boggan
- Medical Service, Durham VA Medical Center, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Peter Caldwell
- Medical Service, New Orleans VA Medical Center, New Orleans, Louisiana, USA
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Paul B Cornia
- University of Washington School of Medicine, Seattle, Washington, USA
- Medical Service, VA Puget Sound Healthcare System, Seattle, Washington, USA
| | - Jessica Cyr
- Medical Service, Pittsburgh VA Medical Center, Pittsburgh, Pennsylvania, USA
- Pittsburgh University School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Erik Ehlers
- Medical Service, Veteran Affairs Nebraska-Western Iowa Health Care System, Omaha, Nebraska, USA
- University of Nebraska Medical Center, College of Medicine, Omaha, Nebraska, USA
| | - Joel Elzweig
- Medical Service, White River Junction VA Medical Center, White River Junction, Vermont, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Patrick Godwin
- Medical Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Kirsha S Gordon
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michelle Guidry
- Medical Service, New Orleans VA Medical Center, New Orleans, Louisiana, USA
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Jeydith Gutierrez
- Section of Hospital Medicine, Iowa City VA Healthcare System, Iowa City, Iowa, USA
- Department of Medicine, University of Iowa Health Care, Carver College of Medicine, Iowa City, Iowa, USA
| | - Daniel Heppe
- VA Eastern Colorado Health Care System, Aurora, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Matthew Hoegh
- VA Eastern Colorado Health Care System, Aurora, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Anand Jagannath
- Medical Service, VA Portland Healthcare System, Portland, Oregon, USA
- Oregon Health and Science University School of Medicine, Portland, Oregon, USA
| | - Peter Kaboli
- Section of Hospital Medicine, Iowa City VA Healthcare System, Iowa City, Iowa, USA
- Department of Medicine, University of Iowa Health Care, Carver College of Medicine, Iowa City, Iowa, USA
| | - Michael Krug
- University of Washington School of Medicine, Seattle, Washington, USA
- Medical Service, Boise VA Medical Center, Boise, Idaho, USA
| | - James D Laudate
- Medical Service, White River Junction VA Medical Center, White River Junction, Vermont, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Christine Mitchell
- Medical Service, Veteran Affairs Nebraska-Western Iowa Health Care System, Omaha, Nebraska, USA
| | - Micah Pescetto
- Medical Service, VA Kansas City Health Care, Kansas City, Missouri, USA
| | - Benjamin A Rodwin
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Matthew Ronan
- Medical Service, General Internal Medicine Section, VA Boston Healthcare System, West Roxbury, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Richard Rose
- Medical Service, Salt Lake City VA Medical Center, Salt Lake City, Utah, USA
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Meghna N Shah
- University of Washington School of Medicine, Seattle, Washington, USA
- Medical Service, VA Puget Sound Healthcare System, Seattle, Washington, USA
| | - Andrea Smeraglio
- Medical Service, VA Portland Healthcare System, Portland, Oregon, USA
- Oregon Health and Science University School of Medicine, Portland, Oregon, USA
| | - Meredith Trubitt
- Medical Service, Atlanta VA Medical Center, Atlanta, Georgia, USA
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Matthew Tuck
- Medical Service, VA Washington DC Health Care System, Washington, District of Columbia, USA
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Jaclyn Vargas
- Medical Service, San Diego VA Medical Center, San Diego, California, USA
| | - Peter Yarbrough
- Medical Service, Salt Lake City VA Medical Center, Salt Lake City, Utah, USA
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Craig G Gunderson
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
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