Fecha de publicación: -- Fuente: PubMed "Cannabis" Alcohol Clin Exp Res (Hoboken). 2026 Nov;50(11):e70397. doi: 10.1111/acer.70397.ABSTRACTBACKGROUND AND AIMS: Alcohol-associated hepatitis (AH) carries high short-term mortality. Although concomitant substance use is common in patients with AH, its impact on clinical outcomes remains unclear. We aimed to determine the prevalence of active substance use and evaluate its association with clinical outcomes in a large, multinational cohort of hospitalized patients with AH.METHODS: We conducted a prospective, multicenter study across 38 centers in 13 countries (2015-2024). Adults meeting National Institute on Alcohol Abuse and Alcoholism (NIAAA) criteria for AH were enrolled. The primary outcome was all-cause mortality stratified by substance use. Fine-Gray subdistribution hazard models were used to identify mortality predictors, with liver transplantation (LT) treated as a competing event.RESULTS: We included 814 patients, with a mean age of 49.5 ± 10.6 years, and 88.8% were male. Active cannabis and cocaine use were reported in 6.1% and 5.5%, respectively. Over follow-up, 210 patients (25.8%) died, and 35 (4.3%) underwent LT. In multivariable analysis, active cannabis use independently predicted higher mortality (sHR 2.49, 95% CI 1.52-4.09; p < 0.001), along with higher MELD scores and ACLF grades 2-3. Corticosteroid therapy (sHR 0.57, 95% CI 0.38-0.85; p = 0.007) and higher educational levels (sHR 0.34 and 0.31 for intermediate and highest categories, respectively) were associated with improved survival.CONCLUSIONS: Active substance use-particularly cannabis use-was independently associated with increased mortality in patients hospitalized with AH, even after adjusting for liver disease severity and accounting for transplantation as a competing event. These findings identify a behavioral dimension of AH severity and highlight the need to integrate addiction medicine and psychiatric care into hepatology practice to improve outcomes.PMID:43002115 | DOI:10.1111/acer.70397