S2618 Real World Impact of Guideline-Adherent Nutritional Support on Outcomes in Hospitalized Patients With Alcohol Associated Hepatitis

Introduction: Malnutrition is a significant contributor to poor outcomes in alcohol-associated hepatitis (AH). Despite guidelines recommending aggressive nutritional support, the real-world implementation and impact of these recommendations remain poorly understood. Methods: We conducted a retrospective study of adult patients diagnosed with AH who were admitted to an academic tertiary care center between 1/1/2023 and 12/31/2023. We included patients with probable or definite AH per the National Institute on Alcohol Abuse and Alcoholism (NIAAA) Alcoholic Hepatitis Consortia criteria. Nutritional interventions were categorized as guideline-adherent (≥35 kcal/kg/day with thiamine and folic acid supplementation) or non-adherent. The primary outcome was 90-day mortality. Multivariable Cox-regression models were used to assess the independent association between nutritional guideline adherence and 90-day mortality. Results: A total of 101 patients with AH were included for analysis. The cohort had a median age of 47 years, with 42% being woman, and a median body mass index (BMI) of 28 kg/m2. The median phosphatidylethanol level at admission was 212 ng/dL, and the median Model for End-Stage Liver Disease (MELD) score was 25. Only 20% of patients received guideline-adherent nutritional support. Guideline-adherent nutrition was associated with lower 90-day mortality (5% vs 25%, P = 0.05), but no differences were found in median hospital length of stay (6 vs 7 days, P = 0.31) or need for intensive care unit admission (45% vs 43%, P = 0.89). After adjusting for age, sex, MELD score, and BMI, guideline-adherent nutrition was independently associated with reduced hazards of 90-day mortality (HR 0.11, 95% CI 0.14-0.85, P = 0.04). Subgroup analysis of patients with severe AH, defined as MELD >20 (76% of cohort), showed consistent results, where guideline-adherence was associated with reduced 90-day mortality (HR 0.10, 95% CI 0.10-0.81, P = 0.03). Conclusion: In this real-world cohort, only 20% of AH patients received guideline-recommended nutritional support, which was independently associated with an 89% reduction in 90-day mortality risk. These findings underscore the critical need for targeted interventions to improve nutritional support implementation in AH, potentially offering a cost-effective strategy to significantly improve outcomes in this high-risk population.