A Prospective Observational Study of AUDIT-Based Risk Stratification and Drinking Guidance Provided by Hepatologists in Patients with Alcoholic Liver Disease.

Objectives Alcoholic liver disease is the leading cause of cirrhosis and liver failure in Japan. We assessed hepatologist-led interventions stratified using the alcohol use disorder identification test. Methods This was a single-center, prospective study. Outcomes included total alcohol consumption, number of heavy drinking days, drinking risk level, and liver function over 24 weeks. Patients Patients with chronic liver disease were stratified into three groups according to alcohol use disorder identification test scores: <10 (education only), 10-19 (hepatologist-led intervention), and ≥20 (psychiatric referral). Patients in the hepatologist-led group received drinking guidance, psychosocial support, and nalmefene, when indicated. Results Between August 2022 and September 2025, 932 patients were screened; 823, 78, and 31 had alcohol use disorder identification test scores of <10, 10-19, and ≥20 points, respectively. Of the 78 patients in the hepatologist-led intervention group, 74 completed follow-up. In this group, median total alcohol consumption decreased from 63.1 to 35.1 g/day (p=0.001) and heavy-drinking days from 17.0 to 11.3 days/month (p=0.002). Drinking risk level downstaging was achieved in 52 patients (70.2%), who showed significant improvements in aspartate aminotransferase (p=0.027) and γ-GTP (p=0.014) levels and experienced fewer cirrhosis-related complications in comparison to patients without downstaging. Logistic regression identified baseline hepatocellular carcinoma as an independent predictor of drinking risk-level downstaging (odds ratio, 5.23; 95% confidence interval, 1.10-15.3). Conclusions Hepatologist-led alcohol use disorder identification test-based management of alcoholic liver disease reduces alcohol intake. Drinking risk-level downstaging has been linked to improved liver biochemistry and clinical outcomes, offering a practical strategy in which psychiatric resources are limited.