High incidence of advanced liver disease and mortality in patients presenting with alcohol use disorder

BACKGROUND: Little is known about the long-term risk of developing cirrhosis in patients with alcohol use disorder (AUD). METHODS: This was a retrospective cohort of patients with AUD presenting to healthcare centers between January 2006 and June 2017. Individuals ≥18 years old with a diagnosis of AUD based on ICD-9 and ICD-10 codes were included. Patients with concurrent cirrhosis were excluded. Then, patients were followed until August 2021 for the development of complications or mortality. RESULTS: A total of 32,808 patients with AUD were included in the final analysis. During an average follow-up of 5.7 years, 12.3% of patients developed incident cirrhosis, and the overall mortality was 20.2%. The risk of cirrhosis increased in patients with diabetes mellitus (DM) [hazard ratio (HR), 1.52; 95% CI, 1.41-1.63; p<0.001] and hepatitis C (HR, 3.15; 95% CI, 2.93-3.39; p<0.001), whereas African American (AA) race had a protective effect (HR, 0.76; 95% CI, 0.7-0.82; p<0.001). Development of cirrhosis doubled the mortality rate (HR, 2.55; 95% CI, 2.39-2.72; p<0.001). The presence of DM, concomitant hepatitis C infection, and non-AA race collectively conferred a greater risk of cirrhosis and mortality in individuals with AUD. INTERPRETATION: Patients presenting with AUD are at high risk for developing incident cirrhosis and mortality. Concurrent DM and hepatitis C increase the risk of cirrhosis and mortality. Early intervention in patients presenting with AUD is urgently warranted.