Hepatology (Baltimore, Md.)
May 6, 2026 · via Europe PMC
Exploring the interaction between metabolic dysfunction and alcohol-associated hepatitis: A global study.
Cari V, Perez MI, Tellez I, +43 more, Arab JP.
AI summary — for doctors, generated from the abstract only
Among hospitalized patients with severe alcohol-associated hepatitis, cardiometabolic risk factors did not independently increase mortality.
What was studied
Multinational prospective cohort of 936 hospitalized patients with AH at 32 centers in 14 countries (2015-2024), using adjusted competing-risk models with liver transplantation as a competing event.
Key findings
- 46.6% had at least one cardiometabolic risk factor, and 180-day survival was 72.9% with no difference by CMRF status (log-rank p = 0.453)
- Older age, greater alcohol intake, higher MELD and ACLF grade 2-3 predicted mortality, but no individual CMRF did
- Mortality was modestly lower at BMI 25-40 and higher above 40 kg/m2
Clinical relevance
Prognosis in severe AH is driven by liver failure severity, not metabolic comorbidity; the BMI pattern may reflect nutrition.
Who should care
Limitations
Observational design, 88.9% male, and the BMI association may reflect confounding such as nutritional status as the authors suggest.
Metabolic dysfunction did not worsen survival in severe AH.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background and aims
Although the role of cardiometabolic risk factors (CMRFs) has been characterized in steatotic liver disease, their role in the severity of alcohol-associated hepatitis (AH) remains unclear. We aimed to evaluate the impact of CMRFs on mortality.
Approach and results
Multinational prospective cohort study (2015-2024) including hospitalized patients with AH across 32 centers in 14 countries. Diagnosis of AH was made using the National Institute on Alcohol Abuse and Alcoholism criteria. Analyses included adjusted competing-risk models by age, sex, ethnicity, history of cirrhosis, CMRF, corticosteroid use, MELD, and acute-on-chronic liver failure grade, with liver transplantation as a competing risk. Nine hundred thirty-six participants were included; the mean age was 48±11.2 years, and 88.9% were male. At least 1 CMRF was present in 46.6%; median body mass index was 24.2 kg/m 2 [IQR: 22.8-28.2], prevalence of diabetes 17.6%, hypertension 16.5%, and dyslipidemia 5.8%. Median MELD was 24.4 (19.3-31.4), 86.7% had severe AH, and 180-day survival was 72.9%. Survival did not differ by CMRF status (log-rank p =0.453). In adjusted competing-risk models, higher age (subdistribution hazard ratio [sHR] 1.03; 95% CI: 1.01-1.04), greater alcohol intake (per g/day; sHR: 1.001; 95% CI: 1.000-1.002), MELD (sHR: 1.04; 95% CI: 1.01-1.06), and acute-on-chronic liver failure grade 2-3 (sHR: 2.34 and 4.34) predicted mortality. However, no individual CMRF independently increased mortality. A prespecified nonlinear body mass index analysis showed modestly lower mortality between 25 and 40 kg/m², with a higher risk above 40 kg/m².
Conclusions
Among patients with severe AH, metabolic dysfunction was not associated with increased mortality. Although a higher body mass index was associated with slightly lower mortality in AH, this may reflect better nutritional status rather than a true protective effect.
DOI
10.1097/hep.0000000000001780
PMID
42090455
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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