A Brief Intervention on Alcohol Use Disorder Is Associated With Treatment Access for Inpatients With Alcohol-Associated Liver Disease.

IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Journal of Addiction Medicine Pub Date : 2024-08-16 DOI:10.1097/ADM.0000000000001371
Patrick A Twohig, Alena Balasanova, Lauren Cooper, Michelle Le, Nathalie Khoury, Wuittporn Manatsathit, Marco Olivera, Thoetchai Bee Peeraphatdit
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Abstract

Abstract:

Background: Alcohol-associated liver disease (ALD) is the most common indication for liver transplantation in the United States. Alcohol use disorder (AUD) treatment is recommended in all patients with ALD and AUD, but it remains underutilized.

Aims: To identify predictors of AUD treatment and to assess 30-day readmission, return to drinking, and 1-year transplant-free survival.

Methods: Retrospective single-center cohort study of consecutive patients hospitalized with ALD and AUD between 2018 and 2020. Patients who died or were lost to follow-up at 90 days after hospitalization were excluded. AUD treatment was defined as receiving medication or participating in residential, outpatient, or support groups within 90 days of discharge.

Results: One hundred nine patients were included. Mean age was 51.7 years, and 63% were male. Fifty-six (51%) patients received AUD treatment, and 23 (21%) patients received more than one treatment. Predictors of AUD treatment were younger age (OR, 1.07 [95% CI, 1.04-1.12]; P < 0.001), gastroenterology/hepatology consult (AOR, 8.54 [95% CI, 2.55-39.50]; P = 0.0002), addiction psychiatry consult (AOR, 2.77 [95% CI, 1.16-6.84]; P = 0.02), and a brief AUD intervention (AOR, 18.19 [95% CI, 3.36-339.07]; P = 0.0001). Cirrhosis decompensation, MELD-Na score, and insurance status were not associated with treatment. Thirty-one patients (28.4%) were readmitted, and 29 (26.6%) remained abstinent 30 days from discharge. Patients who received treatment had improved transplant-free survival (HR, 0.44, P = 0.04).

Conclusion: A brief intervention on AUD had the strongest association with receiving AUD treatment in our cohort. Further efforts to incorporate brief interventions when offering AUD treatment to patients with ALD may be beneficial.

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对酒精相关肝病住院患者进行酒精使用障碍简短干预与获得治疗有关。
摘要:背景:酒精相关性肝病(ALD)是美国最常见的肝移植适应症。目的:确定酒精相关性肝病(ALD)治疗的预测因素,评估30天再入院率、恢复饮酒率和1年无移植生存率:对2018年至2020年间因ALD和AUD住院的连续患者进行回顾性单中心队列研究。排除住院后90天死亡或失去随访的患者。AUD治疗定义为出院后90天内接受药物治疗或参加住院、门诊或支持小组:结果:共纳入 199 名患者。平均年龄为 51.7 岁,63% 为男性。56名(51%)患者接受了 AUD 治疗,23 名(21%)患者接受了一种以上的治疗。AUD 治疗的预测因素包括年龄较小(OR,1.07 [95% CI,1.04-1.12];P < 0.001)、胃肠病学/肝病学咨询(AOR,8.54 [95% CI,2.55-39.50];P = 0.0002)、成瘾精神病咨询(AOR,2.77 [95% CI,1.16-6.84];P = 0.02)和简短的 AUD 干预(AOR,18.19 [95% CI,3.36-339.07];P = 0.0001)。肝硬化失代偿、MELD-Na 评分和保险状况与治疗无关。31名患者(28.4%)再次入院,29名患者(26.6%)在出院后30天仍未复发。接受治疗的患者无移植生存率有所提高(HR,0.44,P = 0.04):结论:在我们的队列中,针对 AUD 的简短干预与接受 AUD 治疗的关系最为密切。在为 ALD 患者提供 AUD 治疗时,进一步努力纳入简短干预可能会有所裨益。
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来源期刊
Journal of Addiction Medicine
Journal of Addiction Medicine 医学-药物滥用
CiteScore
6.10
自引率
9.10%
发文量
260
审稿时长
>12 weeks
期刊介绍: The mission of Journal of Addiction Medicine, the official peer-reviewed journal of the American Society of Addiction Medicine, is to promote excellence in the practice of addiction medicine and in clinical research as well as to support Addiction Medicine as a mainstream medical sub-specialty. Under the guidance of an esteemed Editorial Board, peer-reviewed articles published in the Journal focus on developments in addiction medicine as well as on treatment innovations and ethical, economic, forensic, and social topics including: •addiction and substance use in pregnancy •adolescent addiction and at-risk use •the drug-exposed neonate •pharmacology •all psychoactive substances relevant to addiction, including alcohol, nicotine, caffeine, marijuana, opioids, stimulants and other prescription and illicit substances •diagnosis •neuroimaging techniques •treatment of special populations •treatment, early intervention and prevention of alcohol and drug use disorders •methodological issues in addiction research •pain and addiction, prescription drug use disorder •co-occurring addiction, medical and psychiatric disorders •pathological gambling disorder, sexual and other behavioral addictions •pathophysiology of addiction •behavioral and pharmacological treatments •issues in graduate medical education •recovery •health services delivery •ethical, legal and liability issues in addiction medicine practice •drug testing •self- and mutual-help.
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