Alcohol‐Associated Pancreatitis Confers Higher Risk of Advanced Liver Disease Than Alcohol Withdrawal Syndrome
5 affiliations
- 1Department of Medicine Virginia Commonwealth University Richmond Virginia USA
- 2Department of Medicine Cleveland Clinic Foundation Cleveland Ohio USA
- 3Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine Virginia Commonwealth University Richmond Virginia USA
- 4Departamento de Gastroenterología, Escuela de Medicina Pontificia Universidad Católica de Chile Santiago Chile
- 5MASLD Research Center, Division of Gastroenterology and Hepatology University of California San Diego California USA
Abstract
Background and Aim: Alcohol‐associated liver disease frequently presents late as decompensated cirrhosis, representing a missed opportunity for intervention. Extrahepatic alcohol‐related presentations requiring acute care, such as alcohol‐associated pancreatitis and alcohol withdrawal syndrome, may identify heavy drinkers at varying risk for liver disease progression. Whether these presentations differentially predict progression to advanced chronic liver disease is unknown.
Methods: This retrospective cohort study used a United States federated database. Adults with a first diagnosis of alcohol‐associated pancreatitis or alcohol withdrawal syndrome (2016–2023) without pre‐existing liver disease were included. Cohorts were propensity score–matched on demographics, comorbidities, laboratory values, and medications. The primary outcome was advanced chronic liver disease. Secondary outcomes included all‐cause mortality and prescription of medications for alcohol use disorder.
Results: After matching, 3201 patients per cohort were analyzed. Over median follow‐up of 3.5–3.7 years, patients with alcohol‐associated pancreatitis had higher rates of advanced chronic liver disease (9.3% vs. 7.0%; hazard ratio, 1.29; 95% confidence interval, 1.09–1.54; p = 0.004), driven by hepatic decompensation (7.0% vs. 4.6%; hazard ratio, 1.50; 95% confidence interval, 1.22–1.85; p < 0.001). Conversely, patients with alcohol withdrawal syndrome had higher all‐cause mortality (12.7% vs. 9.5%; p < 0.001) and medications for alcohol use disorder prescriptions (15.1% vs. 7.7%; p < 0.001). Negative control analyses supported robustness of findings.
Conclusions: Among patients without pre‐existing liver disease, alcohol‐associated pancreatitis was associated with 29% higher advanced chronic liver disease risk compared with alcohol withdrawal syndrome and may serve as an early marker of hepatotoxic susceptibility supporting prioritized liver surveillance.
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BibTeX
@article{fakhoury2026alcoholassociated,
title = {{Alcohol‐Associated Pancreatitis Confers Higher Risk of Advanced Liver Disease Than Alcohol Withdrawal Syndrome}},
author = {Butros Fakhoury and Leandro Sierra and Krishan Patel and Hyundam Gu and Luis Antonio Díaz and Juan Pablo Arab},
journal = {Journal of Gastroenterology and Hepatology},
year = {2026},
month = sep,
doi = {10.1111/jgh.70761},
url = {https://doi.org/10.1111/jgh.70761},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Alcohol‐Associated Pancreatitis Confers Higher Risk of Advanced Liver Disease Than Alcohol Withdrawal Syndrome
AU - Butros Fakhoury
AU - Leandro Sierra
AU - Krishan Patel
AU - Hyundam Gu
AU - Luis Antonio Díaz
AU - Juan Pablo Arab
PY - 2026
DA - 2026/09/28
JO - Journal of Gastroenterology and Hepatology
DO - 10.1111/jgh.70761
UR - https://doi.org/10.1111/jgh.70761
AB - Background and Aim: Alcohol‐associated liver disease frequently presents late as decompensated cirrhosis, representing a missed opportunity for intervention. Extrahepatic alcohol‐related presentations requiring acute care, such as alcohol‐associated pancreatitis and alcohol withdrawal syndrome, may identify heavy drinkers at varying risk for liver disease progression. Whether these presentations differentially predict progression to advanced chronic liver disease is unknown. Methods: This retrospective cohort study used a United States federated database. Adults with a first diagnosis of alcohol‐associated pancreatitis or alcohol withdrawal syndrome (2016–2023) without pre‐existing liver disease were included. Cohorts were propensity score–matched on demographics, comorbidities, laboratory values, and medications. The primary outcome was advanced chronic liver disease. Secondary outcomes included all‐cause mortality and prescription of medications for alcohol use disorder. Results: After matching, 3201 patients per cohort were analyzed. Over median follow‐up of 3.5–3.7 years, patients with alcohol‐associated pancreatitis had higher rates of advanced chronic liver disease (9.3% vs. 7.0%; hazard ratio, 1.29; 95% confidence interval, 1.09–1.54; p = 0.004), driven by hepatic decompensation (7.0% vs. 4.6%; hazard ratio, 1.50; 95% confidence interval, 1.22–1.85; p < 0.001). Conversely, patients with alcohol withdrawal syndrome had higher all‐cause mortality (12.7% vs. 9.5%; p < 0.001) and medications for alcohol use disorder prescriptions (15.1% vs. 7.7%; p < 0.001). Negative control analyses supported robustness of findings. Conclusions: Among patients without pre‐existing liver disease, alcohol‐associated pancreatitis was associated with 29% higher advanced chronic liver disease risk compared with alcohol withdrawal syndrome and may serve as an early marker of hepatotoxic susceptibility supporting prioritized liver surveillance.
SN - 0815-9319
SN - 1440-1746
ER -