Introduction: Alcohol use disorder (AUD) is a highly prevalent chronic disorder in the USA. Acute alcoholic hepatitis (AAH) is a common complication of significant alcohol use. Up to half of AUD patients have comorbid generalized anxiety disorder (GAD). GAD is a common form of anxiety in adults. Despite the frequency of GAD in AUD patients, there is little research exploring the impact of GAD on AAH. We assessed the outcomes of AAH with concomitant GAD.
Methods: Patients hospitalized for AAH were selected from the 2014 National Inpatient Sample database. ICD-9 CM codes were used to identify diagnoses. Demographic data and outcomes of AAH were compared between a subgroup with GAD and a subgroup without GAD. The outcomes of interest were inpatient mortality, acute hepatic failure, sepsis, acute respiratory failure, acute renal failure (AKI), hepatic encephalopathy, and hypotension/shock. Independent t-tests and chi-squared tests were used to compare means and proportions respectively. A multivariate logistic regression analysis was conducted to establish if GAD is an independent predictor for the outcomes, after adjusting for age, sex, race, and Charlson Comorbidity Index (CCI).
Results: Among 9,931 AAH patients, 1,954 had comorbid GAD. Patients with comorbid GAD were found to be younger (44.6 years old vs. 47.1 years old, p< 0.001), more likely to be male (57.1% vs. 31.5%, p< 0.001), more likely to be white (83.2% vs. 69.3%, p< 0.001), had a lower hospitalization cost ($28,323 vs. $34,965, p< 0.001) and had a lower CCI (0.44 vs. 0.51, p=0.001). There was no significant difference in length of stay (4.7 days with GAD vs. 4.9 days without GAD, p=0.094). After adjusting for age, sex, race, and CCI, GAD was found to be a risk factor for acute hepatic failure (adjusted odds ratio (aOR) 1.87, 95% confidence interval (CI): 1.25-2.80, p=0.002), sepsis (aOR 1.57, 95% CI: 1.15-2.15, p=0.005), acute respiratory failure (aOR 1.43, 95% CI: 1.06-1.93, p=0.020), AKI (aOR 1.59, 95% CI: 1.30-2.00,p< 0.001), hepatic encephalopathy (aOR 1.60, 95% CI: 1.29-1.98, p< 0.001) and hypotension/shock (aOR 1.25, 95% CI: 1.10-1.43, p< 0.001). The aOR for inpatient mortality was not statistically significant (p=0.221).
Discussion: Our study found that GAD is an independent risk factor for acute hepatic failure, sepsis, acute respiratory failure, AKI, hepatic encephalopathy, and hypotension/shock in patients hospitalized with AAH. The baseline inflammatory state found in GAD patients may help explain these findings.
