S1157 Trends and In-Hospital Outcomes of Alpha-1 Antitrypsin Deficiency Liver Disease in Association with Alcohol

Introduction: Alpha-1 antitrypsin deficiency (A1ATd) is a genetic disorder associated with chronic liver disease and cirrhosis. The hepatotoxic insult of alcohol has been found to accelerate the progression of liver damage and hepatocyte degeneration in A1ATd patients. Methods: Using the NIS-HCUP database from 2004-2014 we compared four populations: (1) discharges for all general alcoholic liver disease, (2) discharges for A1ATd, (3) discharges for A1ATd with non-alcoholic liver disease (A-NALD), and (4) discharges for A1ATd with alcoholic liver disease (A-ALD). A list of ICD9 codes was compiled to report occurrences of complications from decompensated cirrhosis and liver failure along with in-hospital mortality, median age at admission, and demographic data. Results: From 2004-2014 there were a total of 61,260 hospital discharges for A1ATd, for which 10,243 (16.7%) and 1,629 (2.66%) were discharges for A-NALD and A-ALD, respectively. In-hospital mortality was 5.35% for A-NALD and 4.36% for A-ALD (P = 0.439). The median age at hospitalization was 56.17 and 51.09 years old for A-NALD and A-ALD, respectively (P = 0.002). Compared with A-NALD, patients with A-ALD had an increased occurrence of hyponatremia, hepatorenal syndrome and anemia. Conclusion: For patients with A1ATd, alcoholic liver disease is associated with a younger age at hospitalization and a more critical hospital course with regards to complications of liver failure. Alcohol abstinence should be reinforced to patients with alpha-1 antitrypsin deficiency.