Introduction: Alcohol-related hepatitis is one of the most severe manifestations of alcohol-related liver disease and has been associated with significant morbidity, mortality, and financial burden. Patients with alcohol use disorders are at risk of leaving against medical advice (LAMA), however there is lack of data in the literature to show which patients are at higher risk. In this study, we investigate and report the specific demographic factors and comorbidities associated with LAMA.
Methods: Patients with a primary or secondary discharge diagnosis of alcohol-related hepatitis (ICD-10 codes K70.4 and K70.1) between January 2016 to December 2019 were included in this study. Demographics, comorbidities, complications, and interventions were studied for patients who LAMA. Multivariate analysis was conducted to elucidate factors contributing to the increased risk of alcohol-related hepatitis
Results: A total of 538,750 patients were admitted with a diagnosis of alcohol-related hepatitis. Of these, 31,500 (5.84%) patients LAMA. Older age, Hispanic ethnicity, private insurance, and higher income status were associated with decreased risk of LAMA while younger age (aOR-4.39, p< 0.001), African American race (aOR-1.35, p< 0.001), lack of insurance (aOR-1.85, p< 0.001), and patients in the lowest income quartile (aOR-1.25, p< 0.001) were associated with the highest risk of LAMA. A concomitant diagnosis of hepatitis C (aOR-1.38, p< 0.001) or opioid use disorder (aOR-1.39, p-0.053) was also associated with higher risk of LAMA. A complete list of demographics and results of multivariate analysis are depicted in Table 1.
Discussion: Our findings demonstrate that significant differences exist between patients with alcohol-related hepatitis who leave against medical advice and those that remain hospitalized until discharge. We believe that this study will help healthcare providers identify patients at risk of LAMA and help promote targeted education of specific subgroups in understanding their disease state to decrease adverse events.
