Gender Differences Among Patients Hospitalized With Cirrhosis in the United States

Abstract

Background & Aims: Gender disparities exist in outcomes among patients with cirrhosis. We sought to evaluate the role of gender on hospital course and in-hospital outcomes in patients with cirrhosis to help better understand these disparities. Study:We analyzed data from the National Inpatient Sample (NIS), years 2009-2013, to identify patients with any diagnosis of cirrhosis. We calculated demographic and clinical characteristics by gender, as well as cirrhosis complications. Our primary outcome was inpatient mortality. We used logistic regression to associate baseline characteristics and cirrhosis complications with inpatient mortality.Results: Our cohort included 553,017 patients with cirrhosis admitted from 2009-2013. Women made up 39% of the cohort; median age was 57 with 66% non-Hispanic White. Women were more likely than men to have non-cirrhosis comorbidities, including diabetes and hypertension, but were less likely to have most cirrhosis complications, including ascites and variceal bleeding. Women were more likely than men to have acute bacterial infections (34.9% vs 28.2%, p < 0.001), and were less likely than men to die in the hospital on univariable (OR 0.88, 95% CI 0.86 -0.90, p < 0.001) and multivariable (OR 0.86, 95% CI 0.83 -0.88, p < 0.001) analysis. Conclusions:In patients hospitalized with cirrhosis, women have lower rates of hepatic decompensating events and higher rates of non-hepatic comorbidities and infections, resulting in lower in-hospital mortality. Understanding differences in indications for and disposition following hospitalization may help with the development of gender-specific cirrhosis management programs to improve long-term outcomes in women and men living with cirrhosis.

Liver-related mortality is similar among men and women with cirrhosis

“…Since we utilized a large population cohort, our findings most closely compare to other large population based studies. A recent study using the National Inpatient Sample noted a decrease in all-cause mortality among women in hospitalized patients with cirrhosis (aOR 0.86, p<0.001), a remarkably comparable effect size to our study [6]. Similarly, a population based cohort of patients with cirrhosis in the United Kingdom found that female sex had a significant protective association against all-cause mortality (aHR for females 0.84, 95% CI (0.77, 0.91)) [10].…”

“…Despite its importance, the relationship between patient sex and outcomes of patients with cirrhosis remains unclear. A recent study in a large sample of hospitalized patients with cirrhosis found that women were 14% less likely to die while hospitalized [6]. This analysis was limited in that it could not track outcomes post discharge and patient sex itself has been associated with admission to the hospital, potentially introducing selection bias [7][8][9].…”

Effect of gender on mortality and causes of death in cirrhotic patients with gastroesophageal varices. A retrospective study in Norway

“…Most studies indicating a gender effect report improved survival in women [1]. A recent study based on approximately 553 000 patients hospitalized with cirrhosis found in-hospital-mortality to be reduced by fourteen percent in females as compared to males [4]. It is not known, however, whether a positive effect of female sex is true for all cirrhotic patients, or whether it is restricted to decompensated patients.…”

Mortality, sepsis, and organ failure in hospitalized patients with cirrhosis vary by type of infection

“…Additionally, UTI represents a disproportionate percentage of infections in women compared with men, and women have higher inpatient overall survival than men in patients with cirrhosis. 30 However, UTI appears to have among the highest rates of multidrug-resistant organisms of other bacterial infections, 31 and can still be associated with a twofold increase in 90-day mortality. 32 As multidrug-resistant infections are becoming more prevalent and have worse outcomes, UTI mortality may be expected to rise in the future.…”