The clinical implication of psychiatric illnesses in patients with alcoholic liver disease: an analysis of US hospitals

David Uihwan Leea Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USACorrespondence[email protected]

https://orcid.org/0000-0001-7129-7532

Harrison Choub Department of Medicine, Tufts University School of Medicine, Washington, MA, USA

Edwin Wangb Department of Medicine, Tufts University School of Medicine, Washington, MA, USA

Gregory Hongyuan Fanb Department of Medicine, Tufts University School of Medicine, Washington, MA, USA

John Hanb Department of Medicine, Tufts University School of Medicine, Washington, MA, USA

Kevin Changb Department of Medicine, Tufts University School of Medicine, Washington, MA, USA

Jean Kwonb Department of Medicine, Tufts University School of Medicine, Washington, MA, USA

Ki Jung Leeb Department of Medicine, Tufts University School of Medicine, Washington, MA, USA

Jeremy Blanchardc Department of Addiction Medicine, University of Washington Boise Program, Boise, ID, USA

Nathalie Helen Urrunagaa Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA

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Pages 689-697 | Received 24 Jan 2022, Accepted 13 Jun 2022, Published online: 19 Jun 2022

Cite this article
https://doi.org/10.1080/17474124.2022.2090337
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ABSTRACT

Background

In this study, we evaluate the clinical impact of psychiatric illnesses (PI) on the hospital outcomes of patients admitted with alcoholic liver disease (ALD).

Methods

From the National Inpatient Sample from 2012–2017, patients with alcoholic cirrhosis or alcoholic hepatitis were selected and stratified using the presence/absence of PI (which was a composite of psychiatric conditions). The cases were propensity score-matched to PI-absent controls and were compared to the following endpoints: mortality, death due to suicide, length of stay (LOS), hospitalization charges, and hepatic complications.

Results

After matching, there were 122,907 PI with and 122,907 without PI. Those with PI were younger (51.8 vs. 51.9 years p = 0.02) and more likely to be female (39.2 vs. 38.7% p = 0.01); however, there was no difference in race. Patients with PI had lower rates of alcoholic cirrhosis but higher rates of alcoholic hepatitis/alcoholic hepatic steatosis. In multivariate, patients with PI had lower rates of all-cause mortality (aOR 0.51 95%CI 0.49–0.54); however, they experienced higher rates of deaths due to suicide (aOR 3.00 95%CI 1.56–5.78) and had longer LOS (aOR 1.02 95%CI 1.01–1.02).

Conclusion

Presence of PI in ALD patients is associated with prolonged hospital stay and higher rates deaths due to suicide.

KEYWORDS:

Alcoholic hepatitis
PI
depression
anxiety
schizophrenia
bipolar disorder

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interest statement:

DU Lee was funded by NIH NIDDK T32 DK067872-17. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Originality of the manuscript:

The authors of the manuscript hereby certify that the figures and tables included in the manuscript are original and have not been previously published.

Specific author contributions:

David Uihwan Lee

Roles: Conceptualization, data curation, formal analysis, investigation, methodology, supervision, validation, writing - original draft, writing - review & editing

Harrison Chou