EXPLORING THE ROLE OF METABOLIC DYSFUNCTION IN ALCOHOL-ASSOCIATED HEPATITIS: A GLOBAL STUDY

Severe alcohol-associated hepatitis (AH) carries high mortality. Although the role of cardiometabolic risk factors (CMRF)—including obesity, type 2 diabetes mellitus (T2DM), hypertension (HTN), and dyslipidemia (DLP)—has been characterized in steatotic liver disease, their role in the severity of AH remains unclear. To evaluate the impact of CMRF on mortality and infection risk in AH. Multinational prospective cohort study (2015–2024) including hospitalized patients with severe AH across 24 centers in 14 countries (Global AlcHep Network). Diagnosis of AH was done using NIAAA criteria. Analyses included competing-risk models, with liver transplantation as a competing risk. Models were adjusted by age, sex, ethnicity, history of cirrhosis, CMRF, corticosteroids use, MELD, and ACLF grade. 935 participants were included. Median BMI was 24.2kg/m2, prevalence of T2DM was 21%, HTN 17%, DLP 7%. In adjusted competing-risk models, age (sHR 1.02, 95%CI: 1.01-1.04; p<0.001), MELD (sHR 1.04, 95%CI: 1.01–1.06; p<0.001), infections (sHR 1.76, 95%CI: 1.28–2.41; p<0.001), and ACLF grade 2 (sHR 1.67, 95%CI: 1.05–2.69; p<0.032) and 3 (sHR 3.06, 95%CI: 1.88–4.99; p<0.001) were associated with higher risk of mortality, while obesity (sHR 0.67, 95%CI: 0.48–0.93; p=0.016) and corticosteroids use (sHR 0.67, 95%CI: 0.49–0.92; p=0.014) were associated with lower mortality. T2DM, HTN and DLP weren’t associated with higher mortality. Metabolic dysfunction was not associated with increased mortality in AH. Although obesity may be a protective factor, these findings could be explained by a better nutritional status than the lean population.