Hepatology-led alcohol treatment discussions and clinical outcomes among patients with alcohol-related cirrhosis

Abstract Background. Alcohol cessation is the cornerstone of treatment for alcohol-related cirrhosis. This study evaluated associations between hepatology-led conversations about alcohol use disorder (AUD) treatment, AUD treatment engagement, and mortality. Methods. This retrospective cohort study included all patients with ICD-10 diagnosis codes for cirrhosis and AUD who were engaged in hepatology care in a single healthcare system in 2015. Baseline demographic, medical, liver disease, and AUD treatment data were assessed. AUD treatment discussions and initiation, alcohol cessation, and subsequent 5-year mortality were collected. Regression models were used to assess the factors associated with treatment initiation and 5-year mortality. Results. Among 496 patients with alcohol-related cirrhosis, 65 patients (13%) were receiving AUD treatment at baseline, including 48 (11%) receiving behavioral therapy alone, 11 (4%) receiving pharmacotherapy alone, and 6 (1%) receiving both. Over the first year after the baseline hepatology visit, 37 patients engaged in AUD treatment, 51 were retained in treatment, and 14 stopped treatment. One third of patients had documentation of AUD treatment discussions in their hepatology notes, in which behavioral treatment was the commonly recommended treatment modality (86%). Among patients not receiving baseline AUD treatment, treatment initiation was significantly associated with treatment discussion with a hepatologist (AOR:4.04, 95% CI:1.88-9.09) and having compensated cirrhosis (AOR:3.15 95% CI:1.04-8.62). Over 5-year follow-up, 152 patients died (35%), and ongoing alcohol use, age, hepatic decompensation, and HCC were significantly associated with mortality in the final survival model. Conclusion. AUD treatment discussions were documented in less than half of hepatology encounters in patients with alcohol-related cirrhosis, though such discussions were strongly associated with AUD treatment initiation.