Substance Use Disorders in Recently Hospitalized Patients With Cirrhosis

Objectives: Cirrhosis is often a consequence of substance use disorders (SUD) and can lead to significant morbidity, mortality, and hospitalizations. We aimed to determine presence and impact of SUD in recently hospitalized patients with cirrhosis, which has not been previously described.

Methods: This is a retrospective study of consecutive patients with cirrhosis seen at a post-discharge hepatology clinic. The presence of clinically-recognized SUD and documented establishment of addiction treatment, as noted in routine clinical care, was determined through medical record review. Number of hospitalizations, 30-day readmissions, and all-cause mortality at 1 year were also examined.

Results: Among 99 patients, 72% were male and the median age was 55 years. The most common etiologies of cirrhosis were alcohol-related liver disease and hepatitis C infection. Alcohol use disorder was documented in 71%. Nearly all patients with clinically-recognized SUD underwent social work evaluation during hospitalization and 65% were referred to addiction treatment. Establishment of addiction care at follow up was documented in 35%. Documented SUD was associated with greater odds of hospitalization over 1 year (adjusted odds ratio 5.77, 95% confidence interval [1.36, 24.49], P = 0.017), but not with 30-day readmissions or mortality.

Conclusions: Clinically-recognized SUD was common in recently hospitalized patients with cirrhosis and associated with at least 1 other hospitalization within a year. Establishment of addiction treatment was documented in only a minority of patients. Further research is needed to determine whether patients with cirrhosis and SUD experience unique barriers to addiction treatment and if integration of SUD care in hepatology settings may be beneficial.