OBJECTIVES Alcohol-associated liver disease is increasing, especially hospitalizations with acute on chronic liver failure and need for liver transplant. We examined trends in prevalence, inhospital mortality, and resource utilization associated with AALD and ACLF in the young. METHODS The National Inpatient Sample (2006-2014) was queried for hospitalizations with a discharge diagnosis of cirrhosis using the International Classification of Diseases, Ninth Edition, codes. ACLF hospitalization was defined as ≥2 organ failures and stratified by age: young (≤35 years) and older (>35 years). RESULTS Of 447,090 AALD admissions (16,126 in young) between 2006 and 2014, ACLF occurred in 29,599 (6.6%), of which 1,143 (7.1%) were in young. Compared with older, admissions in young had more women (35% vs 29%), were obese (11% vs 7.6%), were Hispanics (29% vs 18%), have alcoholic hepatitis (AH) (41% vs 17%), and have ACLF grades 2 or 3 (34% vs 25%), P < 0.001 for all. Between 2006 and 2014, ACLF in AALD among young increased from 2.8% to 5.2%, with an AH proportion from 24% to 42%, P < 0.0001 for both. Young had more complications requiring ventilation (79% vs 76%) and dialysis (32% vs 28%), P < 0.001 for both. Compared with older, ACLF admission in young had longer hospitalization (12 vs 10 days) with higher hospital charges ($127,915 vs $97,511), P < 0.0001 for both, with 20% reduced inhospital mortality (54%-45%), P < 0.001. DISCUSSION AALD-related hospitalizations are increasing in young in the United States, mainly because of the increasing frequency of AH. Furthermore, this disease burden in young is increasing with a higher frequency of admissions with more severe ACLF and consumption of hospital resources. Studies are needed to develop preventive strategies to reduce burden related to AALD and ACLF in young.

中文翻译：

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美国年轻人酒精相关肝病中急性慢性肝衰竭的负担增加

目标 酒精相关性肝病正在增加，尤其是因急性或慢性肝功能衰竭而需要进行肝移植的住院治疗。我们研究了年轻人中与 AALD 和 ACLF 相关的患病率、住院死亡率和资源利用趋势。方法 使用国际疾病分类第九版代码查询全国住院患者样本（2006-2014 年）中出院诊断为肝硬化的住院情况。ACLF 住院定义为≥2 个器官衰竭并按年龄分层：年轻（≤35 岁）和年长（>35 岁）。结果 在 2006 年至 2014 年间 447,090 名 AALD 入院患者（16,126 名青年）中，29,599 名（6.6%）发生了 ACLF，其中 1,143 名（7.1%）为青年。与年长者相比，年轻入院的女性（35% 对 29%）、肥胖（11% 对 7.6%）、为西班牙裔（29% 对 18%）、酒精性肝炎（AH）（41% 对 17%）、ACLF 2 级或 3 级（34% 对 25%），P < 0.001。2006年至2014年，青少年AALD中ACLF从2.8%上升至5.2%，AH比例从24%上升至42%，两者均P < 0.0001。Young 有更多的并发症需要通气（79% 对 76%）和透析（32% 对 28%），两者的 P < 0.001。与老年人相比，年轻患者的 ACLF 住院时间更长（12 天 vs 10 天），住院费用更高（127,915 美元 vs 97,511 美元），两者 P < 0.0001，住院死亡率降低 20%（54%-45%），P < 0.001 . 讨论 在美国，与 AALD 相关的住院率在年轻人中有所增加，主要是因为 AH 的发生频率不断增加。此外，随着更严重的 ACLF 和医院资源消耗的增加，年轻人的这种疾病负担正在增加。需要研究制定预防策略，以减轻年轻人与 AALD 和 ACLF 相关的负担。