Trends, Burden, and Impact of Infections on Outcomes Among Patients With Alcohol-Associated Hepatitis

BACKGROUND: Alcohol-associated hepatitis (AH), characterized by severe inflammation of the liver among patients with heavy alcohol use, has been associated with increased susceptibility to developing infections. This study evaluates the trends, burden, and impact of infections on the clinical course of AH. METHODS: Data from the 2016 to 2022 National Inpatient Sample database were used to identify adult patients with AH. Patients were stratified into 2 groups: those with and without infections. We collected data on patient demographics, liver-related decompensations, comorbidities, and outcomes [in-hospital mortality, sepsis, shock, acute kidney injury (AKI), intensive care unit (ICU) admission, and thrombotic events]. Multivariate logistic/linear regression analysis was used to assess the impact of infections on these outcomes. RESULTS: Among the 917,345 patients with AH, 186,655 (20.3%) developed infections. The most frequent infections observed included urinary tract infection (9%), pneumonia (6.0%), and skin/soft tissue infections (2.7%). After adjusting for confounding factors, patients with infections had higher odds of in-hospital mortality (aOR: 1.84, 95% CI: 1.75-1.95), sepsis (aOR: 1.87, 95% CI: 1.77-1.97), AKI (aOR: 1.78, 95% CI: 1.73-1.84), shock (aOR: 2.54, 95% CI: 2.43-2.65), ICU admissions (aOR: 2.52, 95% CI: 2.42-2.63), pulmonary embolism (aOR: 2.02, 95% CI: 1.74-2.35), and deep vein thrombosis (aOR: 2.39, 95% CI: 2.13-2.70), (all P<0.001). CONCLUSIONS: The development of systemic infections in patients with AH leads to worse clinical outcomes. Early identification, management, and prevention are necessary to prevent adverse outcomes and improve the overall prognosis among these patients.