Substance Use Disorder Is Associated With Alcohol-Associated Liver Disease in Patients With Alcohol Use Disorder

Substance use disorder (SUD) commonly associates with alcohol use disorder (AUD), and certain substances have independently been shown to drive liver injury. In this work, we sought to determine if coexisting SUD in patients with AUD is associated with the presence of alcohol-associated liver disease (ALD). We performed a cross-sectional analysis using the Mass General Brigham Biobank to identify patients based on International Classification of Diseases, Tenth Revision, codes. We performed multivariate analyses accounting for a wide range of demographic and clinical variables to evaluate the association between SUD and ALD. We subsequently used the same method to evaluate the association between SUD and hepatic decompensation. We identified 2848 patients with a diagnosis of AUD; 9.0% of them had ALD, and 25.2% had a history of SUD. In multivariate analyses, patients with SUD were more frequently diagnosed with ALD than those without SUD (odds ratio [OR] = 1.95, P = .001). Furthermore, the number of concurrent SUDs was positively associated with the diagnosis of ALD (OR = 1.33, P < .001). Independent of the presence of other SUDs, opioid use disorder in patients with AUD was associated with ALD (OR = 1.902, P = .02). In subsequent analyses, we found that sedative use disorder was associated with hepatic decompensation (OR = 2.068, P = .03). In patients with AUD, SUD, and particularly opioid use disorder, was independently associated with the diagnosis of ALD.