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

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; anxiety; bipolar disorder; depression; schizophrenia.

Figure 1.

Figure 1 denotes the patient selection procedure of the study.

Figure 2.

Figure 2 represents the multivariate forest plot using all-cause mortality as the final endpoint, with covariates including psychiatric disorders as independent variables.

Figure 3.

Figure 3 represents the multivariate forest plot using death due to suicide as the final endpoint, with covariates including psychiatric disorders as independent variables.