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Wu HY, Chang CC, Yeh CC, Chen MY, Cherng YG, Chen TL, Liao CC. Adverse outcomes after non-hepatic surgeries in patients with alcoholic liver diseases: a propensity-score matched study. BMC Gastroenterol 2022; 22:475. [PMID: 36404314 PMCID: PMC9677632 DOI: 10.1186/s12876-022-02558-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 10/28/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The influence of alcoholic liver disease (ALD) on the postoperative outcomes is not completely understood. Our purpose is to evaluate the complications and mortality after nonhepatic surgeries in patients with ALD. METHODS We conducted a retrospective cohort study included adults aged 20 years and older who underwent nonhepatic elective surgeries using data of Taiwan's National Health Insurance, 2008-2013. Using a propensity-score matching procedure, we selected surgical patients with ALD (n = 26,802); or surgical patients without ALD (n = 26,802) for comparison. Logistic regression was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of postoperative complications and in-hospital mortality associated with ALD. RESULTS Patients with ALD had higher risks of acute renal failure (OR 2.74, 95% CI 2.28-3.28), postoperative bleeding (OR 1.64, 95% CI 1.34-2.01), stroke (OR 1.51, 95% CI 1.34-1.70) septicemia (OR 1.47, 95% CI 1.36-1.58), pneumonia (OR 1.43, 95% CI 1.29-1.58), and in-hospital mortality (OR 2.64, 95% CI 2.24-3.11) than non-ALD patients. Patients with ALD also had longer hospital stays and higher medical expenditures after nonhepatic surgical procedures than the non-ALD patients. Compared with patients without ALD, patients with ALD who had jaundice (OR 4.82, 95% CI 3.68-6.32), ascites (OR 4.57, 95% CI 3.64-5.74), hepatic coma (OR 4.41, 95% CI 3.44-5.67), gastrointestinal hemorrhage (OR 3.84, 95% CI 3.09-4.79), and alcohol dependence syndrome (OR 3.07, 95% CI 2.39-3.94) were more likely to have increased postoperative mortality. CONCLUSION Surgical patients with ALD had more adverse events and a risk of in-hospital mortality after nonhepatic surgeries that was approximately 2.6-fold higher than that for non-ALD patients. These findings suggest the urgent need to revise the protocols for peri-operative care for this population.
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Affiliation(s)
- Hsin-Yun Wu
- grid.412896.00000 0000 9337 0481Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan ,grid.412896.00000 0000 9337 0481Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chuen-Chau Chang
- grid.412896.00000 0000 9337 0481Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan ,grid.412897.10000 0004 0639 0994Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan ,grid.412897.10000 0004 0639 0994Department of Anesthesiology, Taipei Medical University Hospital, 252 Wuxing St., Taipei, 11031 Taiwan
| | - Chun-Chieh Yeh
- grid.411508.90000 0004 0572 9415Team of Liver Transplantation, Department of Surgery, China Medical University Hospital, Taichung, Taiwan ,grid.185648.60000 0001 2175 0319Department of Surgery, University of Illinois, Chicago, USA
| | - Ming-Yao Chen
- grid.412896.00000 0000 9337 0481Division of Gastroenterology and Hepatology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yih-Giun Cherng
- grid.412896.00000 0000 9337 0481Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan ,grid.412896.00000 0000 9337 0481Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ta-Liang Chen
- grid.412896.00000 0000 9337 0481Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan ,grid.412897.10000 0004 0639 0994Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan ,grid.412896.00000 0000 9337 0481Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chien-Chang Liao
- grid.412896.00000 0000 9337 0481Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan ,grid.412897.10000 0004 0639 0994Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan ,grid.412897.10000 0004 0639 0994Department of Anesthesiology, Taipei Medical University Hospital, 252 Wuxing St., Taipei, 11031 Taiwan ,grid.412896.00000 0000 9337 0481Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan ,grid.412896.00000 0000 9337 0481Centers of Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan ,grid.254145.30000 0001 0083 6092School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
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Nielsen AS, Askgaard G, Thiele M. Treatment of alcohol use disorder in patients with liver disease. Curr Opin Pharmacol 2022; 62:145-151. [PMID: 34999372 DOI: 10.1016/j.coph.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 12/18/2022]
Abstract
Alcohol contributes to more than 5% of global mortality, and causes more than half of all liver-related deaths. The Alcohol Use Disorders Identification Test (AUDIT) can be used to detect those patients with hazardous drinking and alcohol dependence who will benefit from psychosocial and pharmacological alcohol treatment. Psychosocial treatments range from brief interventions and cognitive behavioral therapy, to experimental neuropsychological treatments. Psychosocial intervention can be combined with acamprosate or naltrexone as first line pharmacological treatments. For patients with liver disease, abstinence increases survival and is therefore an important treatment goal. Acamprosate is a good choice, as it prevents relapse to drinking with a number needed to treat of 12. There are no reports indicating high risks of liver toxicity for acamprosate or naltrexone, but evidence is scarce. We recommend vigorous screening for alcohol use disorder in liver disease patients, followed by psychosocial intervention and complemented by pharmaceutical therapy.
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Affiliation(s)
- Anette Søgaard Nielsen
- Research Unit of Alcohol Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Gro Askgaard
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark; Department of Medicine, Zealand University Hospital, Køge, Denmark; Center for Clinical Research and Prevention, Frederiksberg University Hospital, Copenhagen, Denmark
| | - Maja Thiele
- Center for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
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Kakunje A, Kanaradi H, Pai G, Karkal R, Nafisa D, Chandrasekaran P. Drinking pattern in persons with alcohol dependence with and without cirrhosis: A hospital-based comparative study. Indian J Psychiatry 2018; 60:189-194. [PMID: 30166674 PMCID: PMC6102971 DOI: 10.4103/psychiatry.indianjpsychiatry_453_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Worldwide, alcohol is the most frequently used and socially accepted hepatotoxin. However, not everyone who has alcohol dependence develops alcoholic cirrhosis, and does quantity/type or pattern of alcohol intake determine the development of cirrhosis? A study of this nature would help in delineating similarities/differences in the drinking pattern between alcohol dependence and alcohol-induced cirrhosis groups. AIM The aim was to study the drinking pattern of persons with alcohol dependence syndrome (ADS) and alcohol-induced cirrhosis. MATERIALS AND METHODS Alcohol Intake database and Severity of Alcohol Dependence Questionnaire (SADQ) were administered to eighty male inpatients with a reliable family member of which forty were in ADS group and forty were in alcohol dependence with cirrhosis group. RESULTS Persons in the cirrhosis group were older with longer duration of drinking. There is no statistically significant difference in the educational status, religion, occupation, socioeconomic class, mean age of onset of drinking, mean age of development of dependence, type of beverage preferred, and initiating/maintaining factors between the two groups. The amount of alcohol consumed was significantly high in the cirrhosis group, with 33.5% in the high severity of dependence. They usually were drinking alone, outside meal times with regular and intermittent binge pattern. CONCLUSION Alcohol dependence and alcohol-induced cirrhosis may be on a continuum but form a different group of heavy drinkers who may require different approaches to management.
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Affiliation(s)
- Anil Kakunje
- Department of Psychiatry, Yenepoya Medical College, Mangalore, Karnataka, India
| | | | - Ganesh Pai
- Professor of Gastroenterology, KMC, Manipal, Karnataka, India
| | - Ravichandra Karkal
- Department of Psychiatry, Yenepoya Medical College, Mangalore, Karnataka, India
| | - Dilshana Nafisa
- Department of Psychiatry, Yenepoya Medical College, Mangalore, Karnataka, India
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Askgaard G, Neermark S, Leon DA, Kjær MS, Tolstrup JS. Hospital contacts with alcohol problems prior to liver cirrhosis or pancreatitis diagnosis. World J Hepatol 2017; 9:1332-1339. [PMID: 29359016 PMCID: PMC5756722 DOI: 10.4254/wjh.v9.i36.1332] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/15/2017] [Accepted: 11/03/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate prior hospital contacts with alcohol problems in patients with alcoholic liver cirrhosis and pancreatitis.
METHODS This was a register-based study of all patients diagnosed with alcoholic liver cirrhosis or pancreatitis during 2008-2012 in Denmark. Hospital contacts with alcohol problems (intoxication, harmful use, or dependence) in the 10-year period preceding the diagnosis of alcoholic liver cirrhosis and pancreatitis were identified.
RESULTS In the 10 years prior to diagnosis, 40% of the 7719 alcoholic liver cirrhosis patients and 40% of the 1811 alcoholic pancreatitis patients had at least one prior hospital contact with alcohol problems. Every sixth patient (15%-16%) had more than five contacts. A similar pattern of prior hospital contacts was observed for alcoholic liver cirrhosis and pancreatitis. Around 30% were diagnosed with alcohol dependence and 10% with less severe alcohol diagnoses. For the majority, admission to somatic wards was the most common type of hospital care with alcohol problems. Most had their first contact with alcohol problems more than five years prior to diagnosis.
CONCLUSION There may be opportunities to reach some of the patients who later develop alcoholic liver cirrhosis or pancreatitis with preventive interventions in the hospital setting.
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Affiliation(s)
- Gro Askgaard
- Department of Hepatology, Copenhagen University Hospital, Copenhagen Ø DK-2100, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen K DK-1353, Denmark
| | - Søren Neermark
- National Institute of Public Health, University of Southern Denmark, Copenhagen K DK-1353, Denmark
| | - David A Leon
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
- Department of Community Medicine, UiT Arctic University of Norway, Tromsø 9019, Norway
| | - Mette S Kjær
- Department of Hepatology, Copenhagen University Hospital, Copenhagen Ø DK-2100, Denmark
| | - Janne S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Copenhagen K DK-1353, Denmark
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Nielsen JK, Olafsson S, Bergmann OM, Runarsdottir V, Hansdottir I, Sigurdardottir R, Björnsson ES. Lifetime drinking history in patients with alcoholic liver disease and patients with alcohol use disorder without liver disease. Scand J Gastroenterol 2017; 52:762-767. [PMID: 28276826 DOI: 10.1080/00365521.2017.1295466] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine the differences in lifetime alcohol intake (LAI) and drinking patterns between patients with alcoholic liver disease (ALD) and alcohol use disorder (AUD) without notable liver injury and between males and females with ALD. METHODS Alcohol drinking patterns were assessed using the Lifetime Drinking History (LDH) a validated questionnaire, during an outpatient visit. Patients with AUD, currently in addiction treatment, were matched for gender and age (±5 years) with the ALD group. RESULTS A total of 39 patients with ALD (26 males and 13 females; median age 58) and equal number of AUD patients were included (median age 56 years). The onset age for alcohol drinking and duration of alcohol consumption was similar in ALD and AUD. The number of drinking days was higher in women with ALD than in women with AUD: 4075 [(3224-6504) versus 2092 (1296-3661), p = .0253]. The LAI and drinks per drinking day (DDD) were not significantly different between patients with ALD and AUD. Females with ALD had lower LAI than males with ALD: 32,934 (3224-6504) versus 50,923 (30,360-82,195), p = .0385, fewer DDD (p = .0112), and lower proportion of binge drinking as compared to males with ALD (p = .0274). CONCLUSIONS The total LAI was similar in patients with ALD and AUD. The number of drinking days over the lifetime was associated with the development of ALD in females. Females with ALD had significantly lower alcohol consumption than men with ALD despite similar duration in years of alcohol intake which supports the concept of female propensity of ALD.
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Affiliation(s)
- Jon Kristinn Nielsen
- a Department of Surgery , The National University Hospital of Iceland , Reykjavik , Iceland
| | - Sigurdur Olafsson
- b Department of Gastroenterology and Hepatology , Landspitali University Hospital , Reykjavik , Iceland
| | - Ottar M Bergmann
- b Department of Gastroenterology and Hepatology , Landspitali University Hospital , Reykjavik , Iceland
| | - Valgerdur Runarsdottir
- d Department of Internal Medicine , The National Center for Addiction Medicine, Vogur Hospital , Reykjavik , Iceland
| | - Ingunn Hansdottir
- d Department of Internal Medicine , The National Center for Addiction Medicine, Vogur Hospital , Reykjavik , Iceland.,e Department of Psychology , The National University Hospital of Iceland, University of Iceland , Reykjavik , Iceland
| | - Ragna Sigurdardottir
- c Department of Internal Medicine , The National University Hospital of Iceland , Reykjavik , Iceland
| | - Einar S Björnsson
- b Department of Gastroenterology and Hepatology , Landspitali University Hospital , Reykjavik , Iceland.,c Department of Internal Medicine , The National University Hospital of Iceland , Reykjavik , Iceland
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Fox KJ, Harris PR, Jessop DC. Experimentally Manipulated Self-Affirmation Promotes Reduced Alcohol Consumption in Response to Narrative Information. Ann Behav Med 2017; 51:931-935. [DOI: 10.1007/s12160-017-9912-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Roy-Charland A, Plamondon A, Homeniuk AS, Flesch CA, Klein RM, Stewart SH. Attentional bias toward alcohol-related stimuli in heavy drinkers: evidence from dynamic eye movement recording. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 43:332-340. [DOI: 10.1080/00952990.2016.1209511] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Annie Roy-Charland
- Department of Psychology, Laurentian University, Sudbury, Ontario, Canada
| | | | - Andrew S. Homeniuk
- Department of Psychology, Laurentian University, Sudbury, Ontario, Canada
| | - Corie Ann Flesch
- Department of Psychology, Laurentian University, Sudbury, Ontario, Canada
| | - Raymond M. Klein
- Department of Psychology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sherry H. Stewart
- Department of Psychology, Dalhousie University, Halifax, Nova Scotia, Canada
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Heyes CM, Baillie AJ, Schofield T, Gribble R, Haber PS. The Reluctance of Liver Transplant Participants with Alcoholic Liver Disease to Participate in Treatment for Their Alcohol Use Disorder: An Issue of Treatment Matching? ALCOHOLISM TREATMENT QUARTERLY 2016. [DOI: 10.1080/07347324.2016.1148515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Pradeep RJ, Dhilip AM, Mysore A. Do SADQ and AUDIT identify independent impacts of alcohol abuse - clinical and biochemical markers respectively? Indian J Psychiatry 2015; 57:278-83. [PMID: 26600582 PMCID: PMC4623647 DOI: 10.4103/0019-5545.166629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We have analyzed extant data to see if Alcohol Use Disorder Identification Test (AUDIT) and Severity of Alcohol Dependence Questionnaire (SADQ) assess overlapping aspects of alcoholism, and how they relate to lab measures of alcoholism. MATERIALS AND METHODS Consecutive male patients between 20 and 50 years were recruited from varied departments of a general hospital. AUDIT and SADQ, as well as liver function tests, were part of the data obtained. RESULTS Despite, a significant correlation between total scores of SADQ and AUDIT (ρ = 0.188, P < 0.021) and some of their sub-scores. SADQ scores alone were significantly correlating with clinical variables of alcoholism such as family history and age of onset; AUDIT did not. On the other hand, AUDIT total scores correlated with total and conjugated bilirubin, while SADQ did not. INTERPRETATION AND CONCLUSION Our data suggests that the two scales, AUDIT and SADQ may be tapping into two different outcomes of increased alcohol use namely clinical and biochemical markers, respectively. SADQ could be useful in studies looking at withdrawal related severity and clinical aspects of alcoholism; while AUDIT could be more suitable for studies looking at alcoholism-related medical morbidity. This needs to be confirmed in larger unselected samples from different community and clinical settings.
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Affiliation(s)
- R Johnson Pradeep
- Department of Psychiatry, St. John's Medical College Hospital, St. John's National Academy of Health Sciences, Bengaluru, Karnataka, India
| | - Andrew M Dhilip
- Department of Psychiatry, St. John's Medical College Hospital, St. John's National Academy of Health Sciences, Bengaluru, Karnataka, India
| | - Ashok Mysore
- Department of Psychiatry, St. John's Medical College Hospital, St. John's National Academy of Health Sciences, Bengaluru, Karnataka, India
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Cook PA, Morleo M, Billington D, Sanderson-Shortt K, Jones C, Gabbay M, Sheron N, Bellis MA, Phillips-Howard PA, Gilmore IT. Evaluation of work-based screening for early signs of alcohol-related liver disease in hazardous and harmful drinkers: the PrevAIL study. BMC Public Health 2015; 15:532. [PMID: 26041363 PMCID: PMC4455281 DOI: 10.1186/s12889-015-1860-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 05/21/2015] [Indexed: 12/04/2022] Open
Abstract
Background The direct cost of excessive alcohol consumption to health services is substantial but dwarfed by the cost borne by the workplace as a result of lost productivity. The workplace is also a promising setting for health interventions. The Preventing Alcohol Harm in Liverpool and Knowsley (PrevAIL) project aimed to evaluate a mechanism for detecting the prevalence of alcohol related liver disease using fibrosis biomarkers. Secondary aims were to identify the additive effect of obesity as a risk factor for early liver disease; to assess other impacts of alcohol on work, using a cross-sectional survey. Methods Participants (aged 36-55y) from 13 workplaces participated (March 2011–April 2012). BMI, waist circumference, blood pressure and self-reported alcohol consumption in the previous week was recorded. Those consuming more than the accepted UK threshold (men: >21 units; female: >14 units alcohol) provided a 20 ml venous blood sample for a biomarker test (Southampton Traffic Light Test) and completed an alcohol questionnaire (incorporating the Severity of Alcohol Dependence Questionnaire). Results The screening mechanism enrolled 363 individuals (52 % women), 39 % of whom drank above the threshold and participated in the liver screen (n = 141, complete data = 124 persons). Workplaces with successful participation were those where employers actively promoted, encouraged and facilitated attendance. Biomarkers detected that 30 % had liver disease (25 %, intermediate; 5 % probable). Liver disease was associated with the frequency of visits to the family physician (P = 0.036) and obesity (P = 0.052). Conclusions The workplace is an important setting for addressing alcohol harm, but there are barriers to voluntary screening that need to be addressed. Early detection and support of cases in the community could avert deaths and save health and social costs. Alcohol and obesity should be addressed simultaneously, because of their known multiplicative effect on liver disease risk, and because employers preferred a general health intervention to one that focused solely on alcohol consumption.
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Affiliation(s)
- Penny A Cook
- School of Health Sciences, University of Salford, Salford, UK.
| | - Michela Morleo
- Centre for Public Health, Liverpool John Moores University, Liverpool, UK.
| | - David Billington
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK.
| | | | - Colin Jones
- Faculty of Health Education and Community, Liverpool John Moores University, Liverpool, UK.
| | - Mark Gabbay
- Health Services Research, University of Liverpool, and Brownlow Health, Liverpool, UK.
| | - Nick Sheron
- Clinical Hepatology, University of Southampton, Southampton, UK.
| | - Mark A Bellis
- College of Health and Behavioural Sciences, Bangor University, Gwynedd, UK.
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Kilbourne BJ, Cummings SM, Levine R. Alcohol diagnoses among older Tennessee Medicare beneficiaries: race and gender differences. Int J Geriatr Psychiatry 2012; 27:483-90. [PMID: 21618286 DOI: 10.1002/gps.2740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 03/29/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND These analyses bolster a sparse body of research focusing on the rate of alcohol disorders among older adults, particularly race and gender subgroups. METHODS We based the study on cross-sectional data from all Medicare billed physician/patient encounters. Analyses of these data included cross-tabulations, difference of means tests, and difference of proportions tests, logistic regression and multinomial logistic regression. These analyses were based Medicare billing records from physician/patient encounters in Tennessee. Data included Tennessee Medicare billings beneficiaries enrolled in Medicare Part B, who saw a physician at least once in 2000. Patients with billings containing ICD-9 codes: 303 (alcohol abuse), 305 (alcohol dependence), 291 (alcohol psychosis), or 571.1-571.3 (alcohol-related liver disease including cirrhosis of the liver) as to primary diagnosis were considered alcohol-disordered. RESULTS Analyses reveal the overall rate of alcohol disorders, subgroup variation in rates and differences in pattern of specific disorders. Merely 0.04% of Tennessee Medicare beneficiaries were diagnosed with any type of alcoholism, a rate much lower than those reported in previous studies. Rates of alcohol disorders varied across groups, with significantly higher rates for Black men. The type alcohol disorder also varied across groups. CONCLUSIONS Many encounters with the medical system result in missed opportunities to identify and treat alcohol disorders, a significant risk factor among older adults. Alcoholism both triggers and exacerbates many chronic conditions among older adults. The earlier in the disease trajectory the more of these conditions could be prevented or more efficiently managed, resulting in substantial savings in health care costs.
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Affiliation(s)
- Barbara Jean Kilbourne
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, USA.
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Weissenborn R, Nutt DJ. Popular intoxicants: what lessons can be learned from the last 40 years of alcohol and cannabis regulation? J Psychopharmacol 2012; 26:213-20. [PMID: 21926420 DOI: 10.1177/0269881111414751] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In this paper we discuss the relative physical, psychological and social harms of the two most frequently used intoxicant drugs in the UK, namely cannabis and alcohol. Over the past 40 years, the use of both drugs has risen significantly with differential consequences. It is argued that increased policing of cannabis use under the current drug classification system will lead to increased criminalization of young people, but is unlikely to significantly reduce the rates of schizophrenia and psychosis. In comparison, increases in alcohol drinking are related to significant increases in liver cirrhosis hospital admissions and mortality, at a time when mortality rates from other major causes are on the decline. A recent expert-led comparison of the health and social harms to the user and to others caused by the most commonly used drugs in the UK showed alcohol to be more than twice as harmful as cannabis to users, and five times as harmful as cannabis to others. The findings underline the need for a coherent, evidence-based drugs policy that enables individuals to make informed decisions about the consequences of their drug use.
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Ryder SD, Aithal GP, Holmes M, Burrows M, Wright NR. Effectiveness of a nurse-led alcohol liaison service in a secondary care medical unit. Clin Med (Lond) 2010; 10:435-40. [PMID: 21117372 PMCID: PMC4952401 DOI: 10.7861/clinmedicine.10-5-435] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Alcohol misuse is a common reason for hospital admission. While there is considerable evidence from other areas that provision of specialised alcohol services can reduce alcohol intake, there is currently less evidence for medical departments in an acute hospital setting. Nottingham hospitals initiated such a service in 2002-3 based around two nurse specialists who provided input to inpatients with alcohol-related physical disease and provided links to community-based services for alcohol misuse. This service assessed 3632 patients over five years and has seen a reduction in hospital admissions, violent incidents against staff and primary care attendances. It is believed that this model of care is an effective means of intervening in people with alcohol-related problems.
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Affiliation(s)
- S D Ryder
- Department of Gastroenterology, Queens Medical Centre Campus, Nottingham University Hospitals NHS Trust.
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Vyssoki B, Steindl-Munda P, Ferenci P, Walter H, Höfer P, Blüml V, Friedrich F, Kogoj D, Lesch OM. Comparison of alcohol-dependent patients at a gastroenterological and a psychiatric ward according to the Lesch alcoholism typology: implications for treatment. Alcohol Alcohol 2010; 45:534-40. [PMID: 20855411 DOI: 10.1093/alcalc/agq059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIMS To assess the clinical and biological status of alcohol-dependent patients admitted to a psychiatric or a gastroenterological ward, assessing and comparing dimensions important for prescribing treatment for withdrawal and relapse prevention. METHODS Eighty patients, alcohol-dependent according to international classification of diseases tenth revision and diagnostic and statistical manual, text revised, version IV, admitted to the Vienna General Hospital between January 2005 and November 2006, were examined, of whom 44 were admitted to the psychiatric ward and 36 to the gastroenterological ward. Dimensions of alcohol dependence were assessed using a computerized structured interview, the Lesch alcoholism typology (LAT). Biological markers and the model for end-stage liver disease (MELD) score defined the severity of alcohol-related physical disturbances. RESULTS As might be expected, gastroenterological patients had more advanced physical diseases than psychiatric patients, and affective disorders and suicidal tendencies were significantly commoner among the psychiatric patients. Thus, LAT Type II patients were overrepresented at the gastroenterological ward and LAT Type III patients at the psychiatric ward. CONCLUSION The severity of somatic diseases and psychiatric disorders as well as the distribution of the four types according to Lesch differ between alcohol-dependent patients admitted to a psychiatric ward or a gastroenterological ward. Regarding the positive long-term outcome, different evidence-based medical treatment approaches for withdrawal and relapse prevention are needed for these patients.
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Affiliation(s)
- Benjamin Vyssoki
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, Austria.
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The epidemiology and clinical characteristics of patients with newly diagnosed alcohol-related liver disease: results from population-based surveillance. J Clin Gastroenterol 2010; 44:301-7. [PMID: 19745759 DOI: 10.1097/mcg.0b013e3181b3f760] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
GOALS We describe the epidemiology of outpatients newly diagnosed with chronic alcoholic liver disease and describe predictors of cirrhosis and referral for specialty care. BACKGROUND Alcohol is a major cause of liver disease in the United States. Most previous work has described hospitalized patients. STUDY Participants were identified through prospective population-based surveillance in gastroenterology practices Multnomah County, Oregon and New Haven County, Connecticut; and primary care and gastroenterology practices from Kaiser Permanente Northern California in Alameda County during 1999 to 2001. Patients were interviewed, a blood specimen obtained, and their medical record reviewed. RESULTS We identified 82 patients from gastroenterology practices with newly diagnosed alcoholic liver disease. Their median age was 50.0 years. 72.0% were male and 79.3% were White. The median age at initiation of alcohol use was 17.0 years. 43.9% of patients had evidence of cirrhosis at the time of diagnosis. Only 40.2% reported alcohol as the cause of their liver disease. Patients with cirrhosis were more likely to be older, have a higher median number of years of heavy alcohol consumption, and to have been hospitalized for a liver-related complication than noncirrhotic patients. An additional 83 primary care patients were more likely to be older, to be drinking alcohol at study interview, and to not have cirrhosis than patients referred for gastroenterology care. CONCLUSIONS Patients with alcoholic liver disease may present at a late stage and may not identify alcohol as a cause for their liver disease. Improved patient screening and education may limit morbidity and mortality.
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Neuropsychological Impairment and Relapse following Inpatient Detoxification in Severe Alcohol Dependence. Int J Ment Health Addict 2009. [DOI: 10.1007/s11469-009-9261-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Addolorato G, Russell M, Albano E, Haber PS, Wands JR, Leggio L. Understanding and treating patients with alcoholic cirrhosis: an update. Alcohol Clin Exp Res 2009; 33:1136-44. [PMID: 19389182 DOI: 10.1111/j.1530-0277.2009.00956.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Alcoholic cirrhosis represents the terminal stage of alcoholic liver disease (ALD) and one of the main causes of death among alcohol abusers. The aim of this review was to provide an update on alcoholic cirrhosis, with an emphasis on recent findings. Increased alcohol consumption in developing countries is expected to increase cirrhosis mortality. There is a need, therefore, to develop new approaches to the prevention of ALD, including more attention to co-factors that may increase risk of ALD (i.e., obesity and diabetes, chronic HCV infection, and smoking). Furthermore, a better understanding of the pathological mechanisms on the basis of alcohol cirrhosis represents a cornerstone in order to develop new pharmacological treatments. Inflammatory and immune responses along with oxidative stress and alterations in adipokine secretion might contribute in different ways to the evolution of alcohol-induced fibrosis/cirrhosis. As of this date, patients with severe alcoholic hepatitis with a Maddrey Discriminant Factor (MDF) 32 should be offered pentoxifylline and/or corticosteroids unless contraindications exist. For ambulatory patients, S-adenosylmethionine (SAMe) may be considered in a motivated patient with nutritional support. Current studies do not support use of anti-tumor necrosis factor (TNF)-alpha antibody. Finally, achieving total alcohol abstinence should represent the main aim in the management of patients affected by any stage of cirrhosis. In the last decades, several drugs able to increase abstinence and prevent alcohol relapse have been evaluated and some of them have obtained approval for alcohol dependence. Patients with alcoholic cirrhosis; however, are usually excluded from such treatments. A recent study demonstrated the efficacy and safety of baclofen in inducing and maintaining alcohol abstinence in cirrhotic alcohol-dependent patients with cirrhosis. All together the information available suggests the need of a multimodal approach in the clinical management of these patients.
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Affiliation(s)
- Giovanni Addolorato
- Institute of Internal Medicine, Catholic University of Rome (GA, LL), Rome, Italy
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Hatton J, Burton A, Nash H, Munn E, Burgoyne L, Sheron N. Drinking patterns, dependency and life-time drinking history in alcohol-related liver disease. Addiction 2009; 104:587-92. [PMID: 19215600 DOI: 10.1111/j.1360-0443.2008.02493.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIMS To examine the hypothesis that increases in UK liver deaths are a result of episodic or binge drinking as opposed to regular harmful drinking. DESIGN A prospective survey of consecutive in-patients and out-patients. SETTING The liver unit of a teaching hospital in the South of England. PARTICIPANTS A total of 234 consecutive in-patients and out-patients between October 2007 and March 2008. MEASUREMENTS Face-to-face interviews, Alcohol Use Disorders Identification Test, 7-day drinking diary, Severity of Alcohol Dependence Questionnaire, Lifetime Drinking History and liver assessment. FINDINGS Of the 234 subjects, 106 had alcohol as a major contributing factor (alcoholic liver disease: ALD), 80 of whom had evidence of cirrhosis or progressive fibrosis. Of these subjects, 57 (71%) drank on a daily basis; only 10 subjects (13%) drank on fewer than 4 days of the week--of these, five had stopped drinking recently and four had cut down. In ALD patients two life-time drinking patterns accounted for 82% of subjects, increasing from youth (51%), and a variable drinking pattern (31%). ALD patients had significantly more drinking days and units/drinking day than non-ALD patients from the age of 20 years onwards. CONCLUSIONS Increases in UK liver deaths are a result of daily or near-daily heavy drinking, not episodic or binge drinking, and this regular drinking pattern is often discernable at an early age.
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Affiliation(s)
- Jennifer Hatton
- Liver Unit, Division of Infection, Inflammation and Repair, University of Southampton, Southampton, UK
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Gleeson D, Jones JS, McFarlane E, Francis R, Gellion C, Bradley MP, Peck RJ. Severity of alcohol dependence in decompensated alcoholic liver disease: comparison with heavy drinkers without liver disease and relationship to family drinking history. Alcohol Alcohol 2009; 44:392-7. [PMID: 19286679 DOI: 10.1093/alcalc/agp008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIM The aim of this study was to compare alcohol dependence severity in patients with severe alcoholic liver disease (ALD) with that in heavy drinkers without liver disease. METHODS Short alcohol dependence data and lifetime alcohol questionnaires applied to unselected heavy alcohol drinkers (>60 units/week (M) or 40 units/week (F) for >5 years) with either (a) decompensated ALD (patients n = 136) or (b) no evidence of serious liver disease by clinical, biochemical and ultrasound evaluation ('controls' n = 148). RESULTS The SADD alcohol dependence severity score (range 0-42) in patients with ALD was >28 (severe dependence) in 36 cases (26%); slightly higher than that in heavy-drinking controls taken as a whole; similar to that in controls who were seeking healthcare but higher than that in controls who were not; and lower than that in controls who attended specialist alcohol services. In ALD patients and controls, the SADD score was higher in those with three or more heavy-drinking first-degree relatives than in those with none. In multiple regression analysis, the SADD score showed independent associations with young age, clinically manifest alcohol dependence, seeking healthcare and the presence of multiple heavy drinking relatives, but not with ALD. CONCLUSIONS Alcohol dependence severity in patients with ALD varies and tends to be lower than that in heavy drinkers seeking treatment at alcohol treatment centres but is not as low as implied in some previous studies. Alcohol dependence severity is associated with young age and family drinking history but is not specifically associated with the development of liver disease.
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Thomson SJ, Westlake S, Rahman TM, Cowan ML, Majeed A, Maxwell JD, Kang JY. Chronic liver disease--an increasing problem: a study of hospital admission and mortality rates in England, 1979-2005, with particular reference to alcoholic liver disease. Alcohol Alcohol 2008; 43:416-22. [PMID: 18385412 DOI: 10.1093/alcalc/agn020] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
AIMS To determine time trends in hospital admissions for chronic liver disease in England between 1989/1990 and 2002/2003, mortality rates in England and Wales between 1979 and 2005, and the influence of alcohol-related disease on these trends. METHODS Hospital episode statistics for admissions in England were obtained from the Information Center for Health and Social Care and mortality data for England and Wales from the Office for National Statistics. RESULTS Hospital admission rates for chronic liver disease increased by 71% in males and 43% in females over the study period. This increase was largely due to alcoholic liver disease, admission rates for which more than doubled between 1989/1990 and 2002/2003. While there was a smaller rise for chronic viral hepatitis B and C, admission rates declined for hepatitis A, autoimmune hepatitis, and primary biliary cirrhosis. Mortality rates for chronic liver disease more than doubled between 1979 and 2005. Two thirds of these deaths were attributable to alcohol-related liver disease in 2005. The highest rate of alcoholic liver disease mortality was in the 45-64 age group, and the largest percentage increase between 1979 and 2005 occurred in the 25-34 age group. CONCLUSIONS Hospital admissions and mortality in England from chronic liver disease are increasing. The underlying reasons are complex, but alcohol-induced liver disease makes a major contribution. There are clear social and health implications if the trend continues and addressing alcohol-related liver disease should be a public health priority.
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Affiliation(s)
- Sam J Thomson
- Department of Gastroenterology and Hepatology, St George's Hospital, Blackshaw Rd, London, England, SW17 0QT, UK
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Abstract
PURPOSE OF REVIEW This review aims to acquaint the reader with advances in 2006 in the epidemiology, genetics, detection, pathogenesis and treatment of alcoholic liver disease. RECENT FINDINGS Important discoveries have been made in pathogenesis and mechanism of disease, with great emphasis on the many pathways leading to oxidative stress, and the novel mechanism of endoplasmic reticulum stress that is proving to be important in the pathogenesis of many liver diseases. The reliability of ethyl glucuronide and other biomarkers for the detection of alcohol abuse is being better established. There have been no treatment advances for alcoholic liver disease but, on balance, steroids are still favored for carefully selected patients with alcoholic hepatitis. Many compounds tested in rodents may now be available for consideration for clinical trials. Criteria for patient selection and refusal for liver transplantation are being established but the 6 months abstinence rule still holds. SUMMARY Insights are being made into the pathogenesis of alcoholic liver disease but safe and effective therapies for both alcoholic hepatitis and alcoholic cirrhosis have yet to be discovered.
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Affiliation(s)
- Adrian Reuben
- Liver Service, Division of Gastroenterology and Hepatology, And Liver Transplant Program, Medical University of South Carolina, Charleston, South Carolina, USA.
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Verrill C, Smith S, Sheron N. Are the opportunities to prevent alcohol related liver deaths in the UK in primary or secondary care? A retrospective clinical review and prospective interview study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2006; 1:16. [PMID: 16776840 PMCID: PMC1513560 DOI: 10.1186/1747-597x-1-16] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Accepted: 06/15/2006] [Indexed: 12/12/2022]
Abstract
Background Deaths from liver cirrhosis have increased at least 8 fold since the 1970's in the UK and further increases are anticipated, whereas in the rest of Europe liver deaths are decreasing. In the UK, we urgently need strategies to detect those who misuse alcohol and are at risk of developing alcoholic liver disease before they get to that point. One potential strategy is to screen admissions to hospital with alcohol related conditions for evidence of alcohol misuse. Surprisingly, there has been no research into the important question of where the opportunities are to detect those who misuse alcohol – primary or secondary care. We attempted to answer this firstly by conducting a retrospective analysis of the medical notes of 94 patients diagnosed with alcohol induced liver cirrhosis between 1st January 1995 and 31st December 2000 at Southampton General Hospital with the purpose of identifying admissions to hospital prior to a diagnosis of alcoholic liver disease. In the second part of the study, we interviewed patients with alcoholic liver disease about their contact with health services. Results Before diagnosis of alcoholic liver disease, 33% (31/94) of the patients had had an admission to hospital for an alcohol related condition. There was a mean of 7 years and 1 month (SD 6 years 3 months) between the first alcohol-related admission and presentation with alcoholic liver disease (in those who had had admissions). The commonest reason for alcohol related admission was falls/fractures/injuries, followed by non-variceal gastro-intestinal bleeds. Patients with alcoholic liver disease who were interviewed had seen their General Practitioner on average at least 2 times per year. Conclusion Most patients who develop alcohol-induced cirrhosis do not have an admission to hospital with an alcohol related condition before developing alcoholic liver disease. Therefore, if we screen patients admitted to hospital with alcohol related conditions for evidence of alcohol misuse, we could potentially detect around a third of those at risk of developing cirrhosis. Although secondary care has an important role to play in detecting those at risk, the main opportunity for detection is in primary care.
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Affiliation(s)
- Clare Verrill
- Histopathology Department, Southampton University Hospitals NHS Trust, Southampton General Hospital, Tremona Road, Southampton. SO16 6YD, UK
| | - Stewart Smith
- Division of Infection, Inflammation and Repair, Southampton University Hospitals NHS Trust, Southampton General Hospital, Tremona Road, Southampton. SO16 6YD, UK
| | - Nick Sheron
- Division of Infection, Inflammation and Repair, Southampton University Hospitals NHS Trust, Southampton General Hospital, Tremona Road, Southampton. SO16 6YD, UK
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