1061 Gender Differences in Characteristics of Hospitalized Patients With Cirrhosis: A Prospective Multicenter Inpatient Cohort Study

Abstract

INTRODUCTION: Women with cirrhosis listed for liver transplant have increased waitlist mortality compared with men, but the reasons for this disparity is not well-established. We hypothesized that women with cirrhosis have different comorbidities and reasons for hospitalizations than men - and explored this hypothesis in a large, multi-center cohort of inpatients with cirrhosis. METHODS: Our cohort included patients with cirrhosis hospitalized non-electively, prospectively enrolled at 4 academic medical centers 1/2013-2/2017. Data collected included comorbidities, reasons for admission, cirrhosis complications, medications, hospital course, and outcomes. Readmission and mortality rates were compared between women and men using logistic regression. RESULTS: Of the 674 hospitalized patients with cirrhosis, 256 (38%) were women. Median age was 56 years; 75% were non-Hispanic White. Women were less likely than men to have cirrhosis from alcohol (34% vs 26%, P < 0.001), and more likely to have NASH (22% vs 15%, P < 0.001). Women and men had similar cirrhosis complications, liver-related medications, MELD (20 vs 20, P = 0.36), and Child-Pugh (9 vs 10, P = 0.36) scores. Women were more likely to have certain non-liver related comorbidities, including insulin-dependent diabetes (23% vs 14%, P = 0.002) and connective tissue disease (4% vs 1%, P = 0.004), as well as to require non-opiate pain medications (14% vs 7%, P = 0.008) or antidepressant/sleep aids (38% vs 28%, P = 0.005). Overall infection rates on admission were similar between women and men (27% vs 22%, P = 0.19), but women were more likely than men to have UTIs (14% vs 4%, P < 0.001) and less likely to have SBP (6% vs 11%, P = 0.04). Rates of other decompensating events were similar between women and men, including GI bleeding, renal dysfunction, and volume overload (P for all > 0.05). There were no differences between women and men in 30d (11% vs 13%, P = 0.60) or 90d (22% vs 27%, P = 0.18) mortality. In logistic regression, female gender was not associated with increased 30d mortality (OR 0.88, 95% CI 0.54-1.43, P = 0.60) or 90d readmission (OR 1.06, 95% CI 0.75-1.48, P = 0.76). CONCLUSION: Although women and men hospitalized with cirrhosis have similar severity of liver disease, they differ by their etiologies of cirrhosis, non-liver related comorbidities, infectious complications, and patterns of medication use. Future studies should further explore the role that these non-liver-related factors play in contributing to well-established gender disparities in waitlist outcomes.

Extra-hepatic comorbidity burden significantly increases 90-day mortality in patients with cirrhosis and high model for endstage liver disease

“…Genderbased disparities in LT eligibility have been described with increased pre-LT and waitlist mortality in women [19,20]. Additionally, gender-based differences in medical comorbidities have been described in hospitalized patients with higher rates of diabetes and connective tissue disease but without evident differences in hospital mortality [21]. In our cohort, there were no gender-based differences in CCI, although women had a trend for more frequent connective tissue disease.…”