Increasing Burden of Acute-On-Chronic Liver Failure Among Alcohol-Associated Liver Disease in the Young Population in the United States

Ashwani K. Singal, Sumant Arora, Robert J. Wong, Sanjaya K. Satapathy, Vijay H. Shah, Yong Fang Kuo, Patrick S. Kamath

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: Alcohol-associated liver disease is increasing, especially hospitalizations with acute on chronic liver failure and need for liver transplant. We examined trends in prevalence, inhospital mortality, and resource utilization associated with AALD and ACLF in the young. METHODS: The National Inpatient Sample (2006-2014) was queried for hospitalizations with a discharge diagnosis of cirrhosis using the International Classification of Diseases, Ninth Edition, codes. ACLF hospitalization was defined as ≥2 organ failures and stratified by age: young (≤35 years) and older (>35 years). RESULTS: Of 447,090 AALD admissions (16,126 in young) between 2006 and 2014, ACLF occurred in 29,599 (6.6%), of which 1,143 (7.1%) were in young. Compared with older, admissions in young had more women (35% vs 29%), were obese (11% vs 7.6%), were Hispanics (29% vs 18%), have alcoholic hepatitis (AH) (41% vs 17%), and have ACLF grades 2 or 3 (34% vs 25%), P < 0.001 for all. Between 2006 and 2014, ACLF in AALD among young increased from 2.8% to 5.2%, with an AH proportion from 24% to 42%, P < 0.0001 for both. Young had more complications requiring ventilation (79% vs 76%) and dialysis (32% vs 28%), P < 0.001 for both. Compared with older, ACLF admission in young had longer hospitalization (12 vs 10 days) with higher hospital charges ($127,915 vs $97,511), P < 0.0001 for both, with 20% reduced inhospital mortality (54%-45%), P < 0.001. DISCUSSION: AALD-related hospitalizations are increasing in young in the United States, mainly because of the increasing frequency of AH. Furthermore, this disease burden in young is increasing with a higher frequency of admissions with more severe ACLF and consumption of hospital resources. Studies are needed to develop preventive strategies to reduce burden related to AALD and ACLF in young.

Original languageEnglish (US)
Pages (from-to)88-95
Number of pages8
JournalThe American journal of gastroenterology
Volume115
Issue number1
DOIs
StatePublished - Jan 1 2020

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Liver Diseases
Alcoholic Hepatitis
Hospitalization
Alcohols
Population
Hospital Mortality
Hospital Charges
International Classification of Diseases
Hispanic Americans
Ventilation
Inpatients
Dialysis
Fibrosis
Acute-On-Chronic Liver Failure
Transplants
Liver

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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Increasing Burden of Acute-On-Chronic Liver Failure Among Alcohol-Associated Liver Disease in the Young Population in the United States. / Singal, Ashwani K.; Arora, Sumant; Wong, Robert J.; Satapathy, Sanjaya K.; Shah, Vijay H.; Kuo, Yong Fang; Kamath, Patrick S.

In: The American journal of gastroenterology, Vol. 115, No. 1, 01.01.2020, p. 88-95.

Research output: Contribution to journalArticle

Singal, Ashwani K. ; Arora, Sumant ; Wong, Robert J. ; Satapathy, Sanjaya K. ; Shah, Vijay H. ; Kuo, Yong Fang ; Kamath, Patrick S. / Increasing Burden of Acute-On-Chronic Liver Failure Among Alcohol-Associated Liver Disease in the Young Population in the United States. In: The American journal of gastroenterology. 2020 ; Vol. 115, No. 1. pp. 88-95.
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abstract = "OBJECTIVES: Alcohol-associated liver disease is increasing, especially hospitalizations with acute on chronic liver failure and need for liver transplant. We examined trends in prevalence, inhospital mortality, and resource utilization associated with AALD and ACLF in the young. METHODS: The National Inpatient Sample (2006-2014) was queried for hospitalizations with a discharge diagnosis of cirrhosis using the International Classification of Diseases, Ninth Edition, codes. ACLF hospitalization was defined as ≥2 organ failures and stratified by age: young (≤35 years) and older (>35 years). RESULTS: Of 447,090 AALD admissions (16,126 in young) between 2006 and 2014, ACLF occurred in 29,599 (6.6{\%}), of which 1,143 (7.1{\%}) were in young. Compared with older, admissions in young had more women (35{\%} vs 29{\%}), were obese (11{\%} vs 7.6{\%}), were Hispanics (29{\%} vs 18{\%}), have alcoholic hepatitis (AH) (41{\%} vs 17{\%}), and have ACLF grades 2 or 3 (34{\%} vs 25{\%}), P < 0.001 for all. Between 2006 and 2014, ACLF in AALD among young increased from 2.8{\%} to 5.2{\%}, with an AH proportion from 24{\%} to 42{\%}, P < 0.0001 for both. Young had more complications requiring ventilation (79{\%} vs 76{\%}) and dialysis (32{\%} vs 28{\%}), P < 0.001 for both. Compared with older, ACLF admission in young had longer hospitalization (12 vs 10 days) with higher hospital charges ($127,915 vs $97,511), P < 0.0001 for both, with 20{\%} reduced inhospital mortality (54{\%}-45{\%}), P < 0.001. DISCUSSION: AALD-related hospitalizations are increasing in young in the United States, mainly because of the increasing frequency of AH. Furthermore, this disease burden in young is increasing with a higher frequency of admissions with more severe ACLF and consumption of hospital resources. Studies are needed to develop preventive strategies to reduce burden related to AALD and ACLF in young.",
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AU - Arora, Sumant

AU - Wong, Robert J.

AU - Satapathy, Sanjaya K.

AU - Shah, Vijay H.

AU - Kuo, Yong Fang

AU - Kamath, Patrick S.

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