Silva, Rita
Mayo Clinic
Unidade de Transplante de Figado e do Hospital de Base da Faculdade de Medicina de São Jose do Rio Preto, Sao Paulo, Brazil.
Citations 1
Exploring the interaction between metabolic dysfunction and alcohol-associated hepatitis: A global study
Cari, Vania , Pérez, María Ignacia , Tellez, Ignacio , Idalsoaga, Francisco, Valsan, Arun , Nair, Gowripriya , Soni, Kriti , Rhoads, S. Fisher , Arnold, Jorge , Ayala-Valverde, Maria, Ramirez-Cadiz, Carolina, Jalal, Prasun K., Ibrahim, Mohamad Ali , Elfeki, Mohamed A., Simian, Daniela , Córdova, Jacqueline, Higuera‐de‐la‐Tijera, Fátima , Silva, Rita, Rocha, Cristina Melo , Araujo, Roberta C., Fontani, Guilherme Massote, Pereira, Gustavo Henrique, Bessone, Fernando, Tanno, Mario, Kisch, Ayelen, Mendizabal, Manual, Marciano, Sebastian, Gomez-Perdiguero, Gonzalo, Montes, Pedro, Salazar, Patricia Guerra, Ramos, Geraldine, Chacko, Kristina R., Skladaný, Lubomir, Maiwall, Rakhi, SIMONETTO, DOUGLAS, Sanyal, A, Shah, Vijay H. , Singal, Ashwani K., Dunn, Winston, Kamath, Patrick S., Loomba, R, Arrese, Marco, Bataller, Ramon, Diaz, Luis Antonio, Arab, Juan Pablo, Elfeki, Mohamed A. , Perez, María I , Idalsoaga, Francisco , Ayala-Valverde, María , Ramirez-Cadiz, Carolina , Jalal, Prasun K , Ibrahim, Mohamad A , Elfeki, Mohamed A , Roblero, Juan P , Simian, Daniela , Velarde-Ruiz Velasco, José Antonio , Cordova-Gallardo, Jacqueline , Higuera-De La Tijera, Fatima , Silva, Rita , Fontani, Guilherme M , Bessone, Fernando , Mendizabal, Manuel , Marciano, Sebastián , Gomez-Perdiguero, Gonzalo , Montes, Pedro , Guerra Salazar, Patricia , Chacko, Kristina R , Simonetto, Douglas A , Sanyal, A J , Singal, Ashwani K , Dunn, Winston , Kamath, Patrick S , Loomba, Rohit , Bataller, Ramon A , Díaz, Luis A , Gormaz, Vania Cari, Téllez, Ignacio García, Idalsoaga, Francisco , Rhoads, Fisher, Ayala-Valverde, María , Jalal, Prasun K. , Roblero, Juan Pablo , Velasco, J.A. Velarde-Ruiz , Araújo, Roberta Chaves , Massote, Guilherme Fontanini, Pereira, Gustavo , Chacko, Kristina R. , Maiwall, Rakhi , Simonetto, Douglas A. , Sanyal, Arun J. , Singal, Ashwani K. , Dunn, Winston , Kamath, Patrick S. , Loomba, Rohit , Arrese, Marco , Díaz, Luis Antonio , Arab, Juan Pablo
Hepatology | May 6, 2026 | Volume: No volume available | Issue: No issue available | Pages: No page available
Introduction: Although the role of cardiometabolic risk factors (CMRF) has been characterized in steatotic liver disease, their role in the severity of alcohol-associated hepatitis (AH) remains unclear. We aimed to evaluate the impact of CMRF on mortality. Methods: Multinational prospective cohort study (2015–2024) including hospitalized patients with severe AH across 32 centers in 14 countries. Diagnosis of AH was made using the NIAAA criteria. Analyses included adjusted competing-risk models by age, sex, ethnicity, history of cirrhosis, CMRF, corticosteroid use, MELD, and ACLF grade, with liver transplantation as a competing risk. Results: 936 participants were included; mean age 48±11.2 years, and 88.9% were male. At least one CMRF was present in 46.6%; median body mass index (BMI) was 24.2 kg/m 2 [IQR: 22.8–28.2], prevalence of diabetes 17.6%, hypertension 16.5%, and dyslipidemia 5.8%. Median MELD was 24.4 [19.3–31.4], 86.7% had severe AH, and 180-day survival was 72.9%. Survival did not differ by CMRF status (log-rank p =0.453). In adjusted competing-risk models, higher age (sHR 1.02; 95%CI:1.01–1.04), greater alcohol intake (per g/day; sHR 1.001; 95%CI:1.000–1.002), MELD (sHR 1.04; 95%CI:1.01–1.06), and ACLF grade 2–3 (sHR 2.34 and 4.34) predicted mortality. However, no individual CMRF independently increased mortality. A prespecified non-linear BMI analysis showed modestly lower mortality between 25–40 kg/m², with a higher risk above 40 kg/m². Conclusion: Among patients with severe AH, metabolic dysfunction was not associated with increased mortality. Although a higher BMI was associated with slightly lower mortality in AH, this may reflect better nutritional status rather than a true protective effect.