P1257 - Inadequate Evaluation and Treatment of Alcohol Use Disorder in Patients With Alcoholic Hepatitis: A Single-Center Retrospective Study

Kristen Ruckstuhl, DO, MS, Nahel Tunio, MD, Charles Thomas, BA, Bolin Niu, MD
Case Western Reserve University / MetroHealth, Cleveland, OH

Introduction: Limited options exist for the treatment of alcoholic hepatitis (AH). Steroids can be utilized in patients predicted to have poor prognosis based on the Maddrey’s Discriminant Function; however, the foundational treatment for alcohol use disorder (AUD) in this population is often overlooked. Therefore, a retrospective study was performed to assess the evaluation and treatment of AUD in patients hospitalized for AH. Those with comorbid psychiatric disorders were compared to those without. Additionally, the proportion of patients who received referrals to Addiction Medicine (AM), Social Work (SW) and GI while inpatient and upon discharge were compared to those made in the outpatient setting.

Methods: A retrospective chart review was performed. The study population included patients hospitalized for AH at MetroHealth Medical Center, a tertiary care center in Cleveland, OH, from December 2017 to February 2020. Patients were identified using the ICD-10 coding system followed by manual chart review to confirm accuracy of the diagnosis. Data was then abstracted manually for each patient. Chi-square tests were used to analyze the data.

Results: This study was comprised of 138 patients, of which 70 (50.7%) had a comorbid psychiatric diagnosis and 68 (49.3%) did not. The mean age of the study population was 56.8. There were 86 males (62.3%) and 52 females (37.7%). There were 93 Caucasians (67.4%) and 128 non-Hispanics (92.8%). The predominant form of insurance was Medicaid for 63 patients (45.7%). Overall, there was a strikingly low proportion of patients who received AUD treatment or referrals to SW and AM (Table 1).

Discussion: There were overall very low rates of prescription for AUD treatment and referral to SW or AM. There were no statistically significant differences in the evaluation and treatment of AUD in those with psychiatric diagnoses versus those without. However, if patients received treatment for AUD, it was most likely in the outpatient setting. Referrals to SW and AM were extremely low compared to referrals to GI, signifying an underutilization of these resources. Those with psychiatric diagnoses were more likely to be prescribed treatment for AUD in the outpatient setting, likely because mental health providers are more comfortable prescribing treatment for AUD. In summary, treatment of these patients needs to involve a multidisciplinary approach, and comorbid substance use and psychiatric disorders are important to address together.


Disclosures:


Kristen Ruckstuhl, DO, MS, Nahel Tunio, MD, Charles Thomas, BA, Bolin Niu, MD. P1257 - Inadequate Evaluation and Treatment of Alcohol Use Disorder in Patients With Alcoholic Hepatitis: A Single-Center Retrospective Study, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.