{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:33:28Z","timestamp":1790775208087,"version":"4.1.0"},"reference-count":57,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Cardiometabolic risk factors (CMRF) are common in alcohol\u2010associated liver disease (ALD), but their impact on clinical outcomes is unclear. We evaluated whether CMRF identifies a higher\u2010risk phenotype among adults with ALD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a multicenter retrospective cohort study within the TriNetX research network, including adults with ALD (ICD\u201010 K70) from 2010 to 2019. CMRFs were defined by overweight\/obesity, dysglycemia, hypertension or dyslipidemia using the steatotic liver disease framework. Individuals with other liver diseases, cancer, prior liver transplantation or pregnancy were excluded. After 1:1 propensity score matching (PSM) on demographics, comorbidities, laboratory indices and medications, we compared ALD with versus without CMRF using Cox models, overall and stratified by cirrhosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After matching, 2942 adults with ALD were included (ALD with CMRF,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091471; without CMRF,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091471). Five\u2010year all\u2010cause mortality was similar between groups (Hazard Ratio [HR]: 1.01, 95% CI 0.83\u20131.23). In contrast, ALD patients with CMRF had higher risks of alcohol\u2010associated hepatitis (HR 2.12, 95% CI 1.62\u20132.79) and a numerically higher risk of major adverse liver outcomes (HR 1.14, 95% CI 0.98\u20131.32). Cardiovascular complications were markedly increased, including major adverse cardiovascular events (HR 3.07, 95% CI 2.14\u20134.39), arrhythmia (12.4% vs. 4.8%, HR 2.24, 95% CI 1.70\u20132.94) and heart failure (HR 3.70, 95% CI 2.11\u20136.47). Infectious events were also more frequent among CMRF patients, including sepsis, urinary tract infection and pneumonia. Associations were generally stronger among patients with cirrhosis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among individuals with ALD, CMRF does not increase short\u2010 to intermediate\u2010term mortality but identifies a phenotype with substantially higher liver, cardiovascular and infectious morbidity. Systematic detection and intensive management of CMRF should be integrated into ALD care pathways.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.70575","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T09:49:46Z","timestamp":1773395386000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Liver, Cardiovascular and Infectious Outcomes in Alcohol\u2010Associated Liver Disease With Cardiometabolic Risk Factors"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9121-165X","authenticated-orcid":false,"given":"Pojsakorn","family":"Danpanichkul","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Texas Tech University Health Sciences Center  Lubbock Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3325-1688","authenticated-orcid":false,"given":"Kwanjit","family":"Duangsonk","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine Chiang Mai University  Chiang Mai Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanfang","family":"Pang","sequence":"additional","affiliation":[{"name":"Affiliated Hospital of Youjiang Medical University for Nationalities  Baise Guangxi China"},{"name":"National Immunological Laboratory of Traditional Chinese Medicines  Baise Guangxi China"},{"name":"Center for Medical Laboratory Science Affiliated Hospital of Youjiang Medical University for Nationalities  Baise Guangxi China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krittameth","family":"Rakwong","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Chiang Mai University  Chiang Mai Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peerapun","family":"Jit\u2010are\u2010roon","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Chiang Mai University  Chiang Mai Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phuuwadith","family":"Wattanachayakul","sequence":"additional","affiliation":[{"name":"Department of Medicine Albert Einstein Healthcare Network  Philadelphia Pennsylvania USA"},{"name":"Division of Gastroenterology and Hepatology, Department of Medicine National University Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6672-649X","authenticated-orcid":false,"given":"Thitiphan","family":"Srikulmontri","sequence":"additional","affiliation":[{"name":"Department of Medicine Albert Einstein Healthcare Network  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Nah","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine National University Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent L.","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donghee","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Stanford University School of Medicine  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos S.","family":"Mantzoros","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Boston VA Healthcare System, and Beth Israel Deaconess Medical Center Harvard Medical School  Boston Massachusetts USA"},{"name":"Faculty of Medicine Harvard University  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mazen","family":"Noureddin","sequence":"additional","affiliation":[{"name":"Houston Research Institute and Houston Methodist Hospital  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karn","family":"Wijarnpreecha","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine University of Arizona College of Medicine  Phoenix Arizona USA"},{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine Banner University Medical Center  Phoenix Arizona USA"},{"name":"BIO5 Institute, University of Arizona College of Medicine\u2010Phoenix  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41575-022-00688-6"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.3350\/cmh.2024.0835"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.3350\/cmh.2025.0384"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.7326\/ANNALS-24-03218"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.3350\/cmh.2024.0987"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41575-023-00822-y"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2010.213553"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/ueg2.70072"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2024.155958"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2025.08.015"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.122.17982"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/ATV.0000000000000153"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(23)00157-7"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(22)00003-1"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.942753"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000000520"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2020-001629"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41575-024-01022-y"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.3350\/cmh.2025.0474"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000001333"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.11619"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(24)00380-7"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003100"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2023.03.024"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.3350\/cmh.2024.0631"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.773342"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2010.18"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2021.154770"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.5009\/gnl16477"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2207599"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmgh.2024.04.009"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840180108"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1478-3231.2005.01130.x"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.7150\/ijbs.99176"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2020.11.038"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000001628"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.13014"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2023.155642"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.70017"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1097\/XCE.0000000000000126"},{"key":"e_1_2_12_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(25)00048-9"},{"key":"e_1_2_12_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(25)00355-1"},{"key":"e_1_2_12_44_1","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000000935"},{"key":"e_1_2_12_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhepr.2024.101250"},{"key":"e_1_2_12_46_1","doi-asserted-by":"publisher","DOI":"10.1080\/00273171.2011.568786"},{"key":"e_1_2_12_47_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwm074"},{"key":"e_1_2_12_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2025.01.003"},{"key":"e_1_2_12_49_1","doi-asserted-by":"publisher","DOI":"10.1111\/acer.70160"},{"key":"e_1_2_12_50_1","doi-asserted-by":"publisher","DOI":"10.1097\/BSD.0000000000000932"},{"key":"e_1_2_12_51_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2024.03.015"},{"key":"e_1_2_12_52_1","doi-asserted-by":"publisher","DOI":"10.1111\/acer.70199"},{"key":"e_1_2_12_53_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc24-1902"},{"key":"e_1_2_12_54_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.70409"},{"key":"e_1_2_12_55_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2019-320446"},{"key":"e_1_2_12_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2025.09.003"},{"key":"e_1_2_12_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2024.11.028"},{"key":"e_1_2_12_58_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2025.02.006"}],"container-title":["Liver International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.70575","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/liv.70575","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.70575","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T05:12:54Z","timestamp":1775884374000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/liv.70575"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,13]]},"references-count":57,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1111\/liv.70575"],"URL":"https:\/\/doi.org\/10.1111\/liv.70575","archive":["Portico"],"relation":{},"ISSN":["1478-3223","1478-3231"],"issn-type":[{"value":"1478-3223","type":"print"},{"value":"1478-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,13]]},"assertion":[{"value":"2025-07-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70575"}}