Lee David U, Bhowmick Kuntal, Shaik Mohammed R, Choi Dabin, Fan Gregory H, Chou Hannah, Bahadur Aneesh, Lee Ki J, Chou Harrison, Schuster Kimmy, Kolachana Sindhura, Jung Daniel, Schellhammer Sophie, Karagozian Raffi
Division of Gastroenterology and Hepatology, University of Maryland, 22 S. Greene St, Baltimore, MD 21201, USA.
Department of Medicine, Warren Alpert Medical School of Brown University, RI 02903, USA.
J Clin Exp Hepatol. 2025 Jan-Feb;15(1):101479. doi: 10.1016/j.jceh.2024.101479. Epub 2024 Jul 4.
The incidence of hepatitis A virus (HAV) infection is on the rise, with a minority of patients at risk for poor outcomes. This study investigates the prognostic impacts of race and gender on hospital outcomes among admitted HAV-infected patients.
Using the National Inpatient Sample from 2012 to 2017, patients admitted with HAV were selected and stratified by gender (male and female) and race (White, Black, Hispanic, Asian-Pacific Islander, Other). Propensity score-matching and statistical analysis were implemented with comparison to the controls ("Female" and "White"). Primary endpoints included mortality, length of stay (LOS), and hospitalization costs, while secondary endpoints consisted of hepatic-related medical complications such as ascites, hepatic encephalopathy, varices, and acute liver failure.
Females with compensated cirrhosis had increased odds of mortality (aOR 2.59, 95% CI: 1.14-5.91, = 0.02). Otherwise, no other differences in mortality were detected between genders and races. Females had a shorter hospital LOS (aOR 0.97, 95% CI: 0.96-0.98, < 0.001), lower adjusted cost ($12,241 vs. $13,510, aOR 0.92, 95% CI: 0.92-0.92, < 0.001), lower odds of esophageal varices (aOR 0.74, 95% CI: 0.57-0.97, = 0.03) and hepatic encephalopathy (aOR 0.67, 95% CI: 0.53-0.84, < 0.001) compared to males. Black patients exhibited higher LOS (aOR 1.06, 95% CI: 1.04-1.08, < 0.001) and adjusted costs ($13,392 vs $12,592, aOR 1.02, 95% CI: 1.02-1.03, < 0.001). Hispanic patients exhibited higher rates of esophageal varices (aOR 2.19, 95% CI: 1.28-3.76, = 0.005) and adjusted costs ($14,202 vs. $12,381, aOR 1.07, 95% CI: 1.07-1.07, < 0.001), and Asian patients experienced higher adjusted costs ($18,426 vs. $13,137, aOR 1.10, 95% CI: 1.10-1.10, < 0.001) compared to White patients.
Various nuanced impacts of gender and race on hospitalization outcomes in HAV infection were observed, with only one subgroup analysis demonstrating a higher rate of mortality. Further research is warranted to better understand these findings and their implications.
甲型肝炎病毒（HAV）感染的发病率正在上升，少数患者有预后不良的风险。本研究调查了种族和性别对住院的HAV感染患者医院结局的预后影响。
利用2012年至2017年的全国住院患者样本，选择HAV感染住院患者，并按性别（男性和女性）和种族（白人、黑人、西班牙裔、亚太岛民、其他）进行分层。采用倾向得分匹配和统计分析，并与对照组（“女性”和“白人”）进行比较。主要终点包括死亡率、住院时间（LOS）和住院费用，次要终点包括腹水、肝性脑病、静脉曲张和急性肝衰竭等肝脏相关的医学并发症。
代偿期肝硬化女性的死亡几率增加（校正比值比[aOR]2.59，95%置信区间[CI]：1.14 - 5.91，P = 0.02）。否则，未检测到性别和种族之间在死亡率上的其他差异。女性的住院时间较短（aOR 0.97，95% CI：0.96 - 0.98，P < 0.001），调整后的费用较低（12,241美元对13,510美元，aOR 0.92，95% CI：0.92 - 0.92，P < 0.001），与男性相比，食管静脉曲张的几率较低（aOR 0.74，95% CI：0.57 - 0.97，P = 0.03）和肝性脑病的几率较低（aOR 0.67，95% CI：0.53 - 0.84，P < 0.001）。黑人患者的住院时间较长（aOR 1.06，95% CI：1.04 - 1.08，P < 0.001）且调整后的费用较高（13,392美元对12,592美元，aOR 1.02，95% CI：1.02 - 1.03，P < 0.001）。西班牙裔患者食管静脉曲张的发生率较高（aOR 2.19，95% CI：1.28 - 3.76，P = 0.005）且调整后的费用较高（14,202美元对12,381美元，aOR 1.07，95% CI：1.07 - 1.07，P < 0.001），与白人患者相比，亚洲患者的调整后费用较高（18,426美元对13,137美元，aOR 1.10，95% CI：1.10 - 1.10，P < 0.001）。
观察到性别和种族对HAV感染患者住院结局有各种细微的影响，只有一项亚组分析显示死亡率较高。有必要进行进一步研究以更好地理解这些发现及其意义。
