S2517 Clinical and Socioeconomic Outcomes in Cirrhosis Patients With Acute Alcohol-Related Complications

Introduction: The incidence of acute alcohol-related complications, particularly intoxication and withdrawal, has increased over the past decade. These complications impact patient health, often requiring critical care and contribute to a substantial socioeconomic burden. While alcohol-related liver disease rises, the association between acute alcohol-related complications and cirrhosis remains understudied. We aim to explore the characteristics and outcomes of cirrhosis patients hospitalized with these complications. Methods: A retrospective cross-sectional analysis was conducted using the National Inpatient Sample (NIS) database from 2016 to 2021. Adult hospitalizations with a primary diagnosis of acute alcohol intoxication or withdrawal and a secondary diagnosis of cirrhosis were included. This group was compared to cirrhosis patients admitted for other causes. Demographics, hospital characteristics, inpatient outcomes—including mortality, cardiopulmonary resuscitation (CPR), mechanical ventilation, renal replacement therapy (RRT), and discharge disposition were assessed using multivariable regression. Healthcare utilization was compared as well. Results: Among 4,579,858 cirrhosis-related hospitalizations, 21,640 (0.5%) involved alcohol intoxication and 70,375 (1.5%) alcohol withdrawal. Patients with alcohol-related complications were older (60.6 vs 51.0 years), more frequently man (72.5% vs 59.2%), and more often White (71.3% vs 66.4%), all P < 0.001. They exhibited lower rates of hepatic decompensation (OR = 0.29, 95% CI: 0.28–0.30) and hepatocellular carcinoma (OR = 0.11, 95% CI: 0.09–0.13), but higher rates of homelessness and mental health conditions (P < 0.001). There were 435 inpatient deaths (0.2% of cirrhosis deaths) in this subgroup. CPR was less common (OR = 0.04, 95% CI: 0.03–0.05), as was RRT (1.8 vs 7.6 per 1,000; OR = 0.04, 95% CI: 0.03–0.05). Mechanical ventilation was required in 2.2% of alcohol-related cases. These patients were less likely to be transferred to transitional care (14.9% vs 21%; OR = 0.66, 95% CI: 0.63–0.68). Average hospital stay was shorter (4.7 vs 6.2 days, P < 0.001). Total 6-year cost for alcohol-related cirrhosis admissions was $880 million, representing 1.1% of all inpatient cirrhosis costs. Conclusion: Despite the economic burden, patients with acute alcohol-related complications in cirrhosis demonstrate better clinical outcomes, suggesting a less severe overall illness compared to those hospitalized primarily for other causes.