BACKGROUND & AIMS Patients admitted to the hospital for alcoholic hepatitis (AH) are at increased risk of readmission and death. We aimed to identify factors associated with readmission, alcohol relapse, and mortality. METHODS We performed a retrospective analysis of consecutive patients admitted with AH to a tertiary care hospital from 1999 through 2016 (test cohort, n = 135). We validated our findings in a prospective analysis of patients in a multi-center AH research consortium from 2013 through 2017 (validation cohort, n = 159). Alcohol relapse was defined as any amount of alcohol consumption within 30 days after hospital discharge. Early alcohol rehabilitation was defined as residential or outpatient addiction treatment or mutual support group participation within 30 days after hospital discharge. RESULTS Thirty-day readmission rates were 30% in both cohorts. Alcohol relapse rates were 37% in the test and 34% in the validation cohort. Following hospital discharge, 27 patients (20%) in the test cohort and 19 patients (16%) in the validation cohort attended early alcohol rehabilitation. There were 53 deaths (39%) in a median follow-up time of 2.8 years and 42 deaths (26%) in a median follow-up time of 1.3 years, respectively. In the test cohort, early alcohol rehabilitation reduced odds for 30-day readmission (adjusted odds ratios [AOR] 0.16; 95% CI, 0.04-0.65; P = .01), 30-day alcohol relapse (AOR, 0.11; 95% CI, 0.02-0.53; P < .001), and death (adjusted hazard ratio [AHR], 0.20; 95% CI, 0.05-0.56; P = .001). In the validation cohort early alcohol rehabilitation reduced odds for 30-day readmission (AOR, 0.30; 95% CI, 0.09-0.98; P = .04), 30-day alcohol relapse (AOR 0.09; 95% CI, 0.01-0.73; P = .02), and death (AHR, 0.20; 95% CI, 0.01-0.94; P = .04). A model combining alcohol rehabilitation and bilirubin identified patients with readmission to the hospital within 30 days with an area under the receiver operating characteristic curve of 0.73. CONCLUSIONS In an analysis from two cohorts of patients admitted with AH, early alcohol rehabilitation can reduce risk of hospital readmission, alcohol relapse, and death and should be considered as a quality indicator in AH hospitalization treatment.

中文翻译：

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酒精性肝炎患者出院后 30 天内进行酒精康复与减少再入院、复发和死亡有关。

背景和目的 因酒精性肝炎 (AH) 入院的患者再入院和死亡的风险增加。我们旨在确定与再入院、酒精复吸和死亡率相关的因素。方法 我们对 1999 年至 2016 年连续入院的 AH 患者进行了回顾性分析（测试队列，n = 135）。我们通过对 2013 年至 2017 年多中心 AH 研究联盟中患者的前瞻性分析验证了我们的发现（验证队列，n = 159）。酒精复吸定义为出院后 30 天内饮酒量不限。早期酒精康复被定义为出院后 30 天内的住院或门诊成瘾治疗或互助小组参与。结果 两个队列的 30 天再入院率均为 30%。酒精复发率在测试中为 37%，在验证队列中为 34%。出院后，测试队列中的 27 名患者 (20%) 和验证队列中的 19 名患者 (16%) 参加了早期戒酒康复。在 2.8 年的中位随访时间和 1.3 年的中位随访时间中分别有 53 例 (39%) 和 42 例 (26%) 死亡。在测试队列中，早期酒精康复降低了 30 天再入院的几率（调整后的优势比 [AOR] 0.16；95% CI，0.04-0.65；P = .01），30 天酒精复发（AOR，0.11；95% CI，0.02-0.53；P < .001）和死亡（调整后的风险比 [AHR]，0.20；95% CI，0.05-0.56；P = .001）。在验证队列中，早期酒精康复降低了 30 天再入院的几率（AOR，0.30；95% CI，0.09-0.98；P = .04），30 天酒精复发（AOR 0.09；95% CI，0.01-0.73；P = .02）和死亡（AHR，0.20；95% CI，0.01-0.94；P = .04）。结合酒精康复和胆红素的模型确定了在 30 天内再次入院的患者，接受者操作特征曲线下的面积为 0.73。结论 在对两个 AH 入院患者队列的分析中，早期戒酒康复可以降低再次入院、酒精复吸和死亡的风险，应将其视为 AH 住院治疗的质量指标。结合酒精康复和胆红素的模型确定了在 30 天内再次入院的患者，接受者操作特征曲线下的面积为 0.73。结论 在对两个 AH 入院患者队列的分析中，早期戒酒康复可以降低再次入院、酒精复吸和死亡的风险，应将其视为 AH 住院治疗的质量指标。结合酒精康复和胆红素的模型确定了在 30 天内再次入院的患者，接受者操作特征曲线下的面积为 0.73。结论 在对两个 AH 入院患者队列的分析中，早期戒酒康复可以降低再次入院、酒精复吸和死亡的风险，应将其视为 AH 住院治疗的质量指标。