Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, San Francisco, CA 94143 United States.
Department of Gastroenterology and Hepatology, Austin Health, Heidelberg 3084, Victoria, Australia.
World J Gastroenterol. 2019 Feb 28;25(8):980-988. doi: 10.3748/wjg.v25.i8.980.
Hospital admissions are common among patients with cirrhosis, but patient factors associated with hospitalization have not been well characterized. Given recent data suggesting increased liver transplant waitlist dropout among women, we hypothesized that women on the liver transplant waitlist would have increased rates of hospitalization compared with men.
To evaluate the role of gender on risk of hospitalization for patients on the liver transplant waitlist, in order to help explain gender disparities in waitlist outcomes.
Patients listed for liver transplant at a single center in the United States were prospectively enrolled in the Functional Assessment in Liver Transplantation Study. Patients included in this retrospective analysis included those enrolled between March 2012 and December 2014 with at least 12 mo of follow up and without hepatocellular carcinoma. The primary and secondary outcomes were hospitalization and total inpatient days within 12 mo, respectively. Logistic and negative binomial regression associated baseline factors with outcomes.
Of the 392 patients, 41% were female, with median (interquartile range) age 58 years (52-63) and model for end- stage liver disease 18 (15-22). Within 12 mo, 186 (47%) patients were hospitalized ≥ 1 time; 48% were readmitted, with a median of 8 (4-15) inpatient days. More women than men were hospitalized (54% 43%; = 0.03). In univariable analysis, female sex was associated with an increased risk of hospitalization [odds ratios (OR) 1.6, 95% confidence interval (CI) 1.0-2.4; = 0.03], which remained significant on adjusted multivariable analysis (OR 1.6, 95%CI: 1.1-2.6; = 0.03). Female gender was also associated with an increased number of inpatient days within 12 mo in both univariable and multivariable regression.
Women with cirrhosis on the liver transplant waitlist have more hospitalizations and inpatient days in one year compared with men, suggesting that the experience of cirrhosis differs between men and women, despite similar baseline illness severity. Future studies should explore gender-specific vulnerabilities to help explain waitlist disparities.
肝硬化患者常住院治疗，但与住院相关的患者因素尚未得到充分描述。鉴于最近的数据表明女性在肝移植候补名单上的脱落率增加，我们假设女性在肝移植候补名单上的住院率会高于男性。
评估性别在肝移植候补患者住院风险中的作用，以帮助解释候补名单结果中的性别差异。
在美国的一家单中心前瞻性纳入接受肝移植的患者参加功能性评估肝移植研究。本回顾性分析纳入了 2012 年 3 月至 2014 年 12 月期间入组且至少随访 12 个月且无肝细胞癌的患者。主要和次要结局分别为 12 个月内的住院和总住院天数。逻辑回归和负二项回归将基线因素与结局相关联。
392 例患者中，41%为女性，中位（四分位距）年龄 58 岁（52-63），终末期肝病模型评分 18（15-22）。12 个月内，186 例（47%）患者住院≥1 次；48%为再入院，中位住院天数为 8（4-15）天。女性住院率高于男性（54% 43%； = 0.03）。单变量分析中，女性性别与住院风险增加相关（比值比 1.6，95%置信区间 1.0-2.4； = 0.03），多变量调整后仍有统计学意义（比值比 1.6，95%置信区间：1.1-2.6； = 0.03）。女性性别在单变量和多变量回归中均与 12 个月内的住院天数增加相关。
与男性相比，在肝移植候补名单上的肝硬化女性在一年内的住院和住院天数更多，这表明尽管疾病严重程度相似，但男性和女性的肝硬化经历不同。未来的研究应探索性别特异性的脆弱性，以帮助解释候补名单上的差异。
