Lee David Uihwan, Kwon Jean, Koo Christina, Han John, Fan Gregory Hongyuan, Jung Daniel, Addonizio Elyse Ann, Chang Kevin, Urrunaga Nathalie Helen
Division of Gastroenterology and Hepatology, University of Maryland Medical Center, Baltimore, Maryland, USA.
School of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA.
Frontline Gastroenterol. 2022 Aug 19;14(2):111-123. doi: 10.1136/flgastro-2022-102113. eCollection 2023.
Autoimmune hepatitis (AIH) can result in end-stage liver disease that requires inpatient treatment of the hepatic complications. Given this phenomenon, it is important to analyse the impact of gender and race on the outcomes of patients who are admitted with AIH using a national hospital registry.
The 2012-2017 National Inpatient Sample database was used to select patients with AIH, who were stratified using gender and race (Hispanics and blacks as cases and whites as reference). Propensity score matching was employed to match the controls with cases and compare mortality, length of stay and hepatic complications.
After matching, there were 4609 females and 4609 males, as well as 3688 blacks and 3173 Hispanics with equal numbers of whites, respectively. In multivariate analysis, females were less likely to develop complications, with lower rates of cirrhosis, ascites, variceal bleeding, hepatorenal syndrome, encephalopathy and acute liver failure (ALF); they also exhibited lower length of stay (adjusted OR, aOR 0.96 95% CI 0.94 to 0.97). When comparing races, blacks (compared with whites) had higher rates of ALF and hepatorenal syndrome related to ALF, but had lower rates of cirrhosis-related encephalopathy; in multivariate analysis, blacks had longer length of stay (aOR 1.071, 95% CI 1.050 to 1.092). Hispanics also exhibited higher rates of hepatic complications, including ascites, varices, variceal bleeding, spontaneous bacterial peritonitis and encephalopathy.
Males and minorities are at a greater risk of developing hepatic complications and having increased hospital costs when admitted with AIH.
自身免疫性肝炎（AIH）可导致终末期肝病，需要住院治疗肝脏并发症。鉴于此现象，利用国家医院登记系统分析性别和种族对AIH住院患者预后的影响具有重要意义。
使用2012 - 2017年国家住院患者样本数据库选择AIH患者，按性别和种族进行分层（将西班牙裔和黑人作为病例组，白人作为参照组）。采用倾向得分匹配法将对照组与病例组进行匹配，并比较死亡率、住院时间和肝脏并发症情况。
匹配后，分别有4609名女性和4609名男性，以及3688名黑人和3173名西班牙裔，白人数量与之相等。多因素分析显示，女性发生并发症的可能性较小，肝硬化、腹水、静脉曲张出血、肝肾综合征、肝性脑病和急性肝衰竭（ALF）的发生率较低；她们的住院时间也较短（校正比值比，aOR 0.96，95%可信区间0.94至0.97）。在比较种族时，黑人（与白人相比）与ALF相关的ALF和肝肾综合征发生率较高，但与肝硬化相关的肝性脑病发生率较低；多因素分析显示，黑人的住院时间较长（aOR 1.071，95%可信区间1.050至1.092）。西班牙裔的肝脏并发症发生率也较高，包括腹水、静脉曲张、静脉曲张出血、自发性细菌性腹膜炎和肝性脑病。
男性和少数族裔在因AIH住院时发生肝脏并发症和住院费用增加的风险更大。
