2026/07/29 by Butros Fakhoury, Jinye Liu, Vinay Jahagirdar +4
paper · doi:10.1111/add.70567
Abstract Background and aims Alcohol use disorder (AUD) follows a chronic, relapsing course but is often overlooked when alcohol consumption is minimal at the time of evaluation. We aimed to assess the prognostic impact of a prior AUD diagnosis on liver‐related outcomes in patients with presumed metabolic dysfunction‐associated steatotic liver disease (MASLD). Design Retrospective cohort study utilizing 1:1 propensity score matching to balance demographics, comorbidities, and laboratory data. Setting A multi‐institutional network of 73 healthcare organizations in the United States, from January 2010 to January 2024. Participants 82 472 adults with newly diagnosed MASLD, comprising 41 236 patients with a documented prior diagnosis of AUD and 41 236 matched controls without AUD. Patients with pre‐existing liver disease (other than MASLD) or subsequent diagnoses of alcohol‐associated liver disease were excluded. Measurements Incidence rates and hazard ratios (HRs) for cirrhosis, hepatic decompensation, hepatocellular carcinoma and the composite of liver transplantation or all‐cause mortality. Findings Over a median follow‐up of 3 years, patients with prior AUD had statistically significantly higher risks of cirrhosis [HR = 1.38; 95% confidence interval (CI) = 1.20–1.59], hepatic decompensation (HR = 1.12; 95% CI = 1.01–1.24) and liver transplantation or mortality (HR = 1.39; 95% CI = 1.31–1.47) compared with non‐AUD controls. This excess risk was attenuated among patients with high metabolic burden (≥3 cardiometabolic risk factors). Conclusions Among patients with presumed metabolic dysfunction‐associated steatotic liver disease (MASLD), a history of alcohol use disorder appears to be independently associated with adverse clinical outcomes, particularly in those with fewer metabolic risk factors. These findings highlight a missed clinical opportunity and support the integration of longitudinal alcohol assessments and behavioral interventions into the care of patients with presumed MASLD.