Sex differences in severity, outcomes, and healthcare utilization in alcohol-associated hepatitis

Table 1 Inpatient encounter demographics and clinical characteristics by sex, n (%)

Attribute	Overall (n = 1386)	Male (n = 875)	Female (n = 511)	P value
Age at encounter (years)				0.0031b
Median	46	47	45
Range	24-79	25-79	24-75
Age group at encounter				0.0088b
≤ 34	197 (14.2)	112 (12.8)	85 (16.6)
35-44	423 (30.5)	260 (29.7)	163 (31.9)
45-54	449 (32.4)	277 (31.7)	172 (33.7)
55-64	266 (19.2)	188 (21.5)	78 (15.3)
≥ 65	51 (3.7)	38 (4.3)	13 (2.5)
Ethnicity				0.3009
Hispanic/Latino	38 (2.8)	21 (2.4)	17 (3.3)
Non-Hispanic/Latino	1231 (89.8)	772 (89.5)	459 (90.4)
Unknown	102 (7.4)	70 (8.1)	32 (6.3)
BMI (kg/m2)				0.0127a
Median	27.2	27.6	26.6
Range	15.8-69.7	17.3-69.7	15.8-51.3
BMI (kg/m2)				0.2583
≤ 18.5	50 (3.6)	26 (3)	24 (4.7)
18.6-24.9	450 (32.5)	272 (31.1)	178 (34.8)
25-29.9	409 (29.5)	265 (30.3)	144 (28.2)
30-34.9	254 (18.3)	171 (19.5)	83 (16.2)
35-39.9	133 (9.6)	85 (9.7)	48 (9.4)
≥ 40	90 (6.5)	56 (6.4)	34 (6.7)
CCI				0.9201
Median	4	4	4
Range	0-16	0-16	0-13
CCI group				0.1693
Mild (≤ 2)	161 (11.6)	91 (10.4)	70 (13.7)
Moderate (3-4)	628 (45.3)	405 (46.3)	223 (43.6)
Severe (≥ 5)	597 (43.1)	379 (43.3)	218 (42.7)
Discriminant function score				0.2262
Median	41.2	39.9	42.5
Range	0-470	0-470	2-374
Discriminant function score				0.2739
< 32	503 (36.3)	327 (37.4)	176 (34.4)
≥ 32	883 (63.7)	548 (62.6)	335 (65.6)
MELD-Na score				0.3012
Median	41.2	39.9	42.5
Range	11-40	11-40	11-40
MELD-Na score				0.8612
< 15	89 (6)	54 (6.2)	29 (5.7)
16-20	247 (17.8)	151 (17.3)	96 (18.8)
21-22	126 (9.1)	77 (8.8)	49 (9.6)
23-26	292 (21.1)	184 (21)	108 (21.1)
27-21	299 (21.6)	186 (21.3)	113 (22.1)
≥ 32	339 (24.5)	223 (25.5)	116 (22.7)

^aP < 0.05.

^bP < 0.01.

Continuous variables were assessed for significance using Mann Whitney U test while categorical variables were assessed using a χ² test. BMI: Body mass index; CCI: Charlson Comorbidity Index; MELD-Na: Model for End-Stage Liver Disease with serum sodium concentration.

Table 2 Encounter diagnoses and procedures, and disposition by sex, n (%)

Attribute	Overall (n = 1386)	Male (n = 875)	Female (n = 511)	P value
Diagnoses
Ascites	1009 (72.8)	365 (71.4)	644 (73.6)	0.3808
Bacteremia	89 (6.4)	62 (7.1)	27 (5.3)	0.1867
Clostridium difficile infection	61 (4.4)	35 (4)	26 (5.1)	0.3407
Esophageal variceal bleed	121 (8.7)	96 (11)	25 (4.9)	0.0001b
Hepatic encephalopathy	575 (41.5)	376 (43)	199 (38.9)	0.1420
Hepatorenal syndrome	231 (16.7)	158 (18.1)	73 (14.3)	0.0691
Pneumonia	234 (16.9)	138 (15.8)	96 (18.8)	0.1483
Portal vein thrombosis	55 (4)	40 (4.6)	15 (2.9)	0.1323
Spontaneous bacterial peritonitis	1 (0.1)	0	1 (0.1)	0.4447
Sepsis	291 (21)	167 (19.1)	124 (24.3)	0.0223a
Substance/alcohol use disorder	1075 (77.6)	687 (78.5)	388 (75.9)	0.2658
Urinary tract infection	271 (19.6)	122 (13.9)	149 (29.2)	< 0.0001b
Medications:
Use of any vasopressors	235 (17)	137 (15.7)	98 (19.2)	0.0919
Norepinephrine	227 (16.4)	130 (14.9)	97 (19)	0.0453a
Epinephrine	58 (4.2)	39 (4.5)	19 (3.7)	0.5074
Vasopressin	118 (8.5)	65 (7.4)	53 (10.4)	0.0582
Use of steroids	503 (36.3)	328 (37.5)	175 (34.3)	0.2263
Use of N-acetylcysteine	137 (9.9)	82 (9.4)	55 (10.8)	0.4023
Procedures:
Renal replacement therapy	36 (2.6)	18 (2.1)	18 (3.5)	0.0980
Hemodialysis	10 (0.7)	8 (0.9)	2 (0.4)	0.2671
Mechanical ventilation	252 (18.2)	149 (17)	103 (10.8)	0.1452
Length of stay (days)
Median	5.6	5.5	5.7	0.4989
Range	0.1-92.7	0.1-92.7	0.1-75.7
Disposition
Hospice	56 (4)	41 (4.7)	15 (2.9)	0.1104
Inpatient death	150 (10.8)	93 (10.6)	57 (11.2)	0.7610
Inpatient death > 48 hours after admission	122 (8.8)	74 (8.5)	48 (9.4)	0.5529
Inpatient death or hospice	206 (14.9)	134 (15.3)	72 (14.1)	0.5365

^aP < 0.05.

^bP < 0.01.

Continuous variables were assessed for significance utilizing Mann Whitney U test while categorical variables were assessed using a χ² test.

Table 3 Logistic regression analysis of odds of encounter mortality

Attribute	Odds ratio	95%CI	P value
Age group (≤ 34 as referent)
35-44	1.57	0.686-3.592	0.2855
45-54	3.128	1.410-6.939	0.005b
55-64	2.732	1.163-6.418	0.0211a
≥ 65	4.318	1.124-16.589	0.0331a
MELD-Na score (≤ 15 as referent)
16-20	1.163	0.119-11.311	0.8967
21-22	0.264	0.014-4.908	0.3717
23-26	2.41	0.282-20.596	0.4217
27-31	1.981	0.235-16.722	0.5300
≥ 32	6.925	0.851-56.355	0.0704
Diagnoses
Hepatic encephalopathy	2.308	1.403-3.797	0.0010b
Hepatorenal syndrome	2.224	1.394-3.551	0.0008b
Pneumonia	2.078	1.276-3.382	0.0033b
Sepsis	2.309	1.419-3.757	0.0008b
Procedures
Mechanical ventilation	9.301	5.724-15.114	< 0.0001b

^aP < 0.05.

^bP < 0.01.

Stepwise logistic regression considering the following variables: Sex, age class, body mass index class, Model for End-Stage Liver Disease with serum sodium concentration class, ascites, bacteremia, clostridium difficile, esophageal variceal bleed, hepatic encephalopathy, pneumonia, portal vein thrombosis, spontaneous bacterial peritonitis, SUD/AUD, urinary tract infection, pressors, steroids, renal replacement therapy, hemodialysis, N-acetylcysteine, mechanical ventilation. MELD-Na: Model for End-Stage Liver Disease with serum sodium concentration.

Table 4 Logistic regression analysis of odds of encounter sepsis

Attribute	Odds ratio	95%CI	P value
Sex
Female	1.41	1.064-1.869	0.0168a
Age group (≤ 34 as referent)
35-44	0.593	0.383-0.917	0.0189a
45-54	0.603	0.394-0.921	0.0192a
55-64	0.577	0.357-0.93	0.0248a
≥ 65	0.263	0.106-0.652	0.0039b
CCI [Mild (≤ 2) as referent]
Moderate (3-4)	2.003	1.054-3.809	0.0340a
Severe (≥ 5)	3.6	1.886-6.874	0.0001b
Discriminant function score (< 32 as referent)
≥ 32	1.669	1.130-2.467	0.0101a
MELD-Na score (≤ 15 as referent)
16-20	0.675	0.266-1.717	0.4097
21-22	0.929	0.342-2.525	0.8854
23-26	1.323	0.539-3.249	0.5409
27-31	2.07	0.846-5.065	0.1111
≥ 32	3.12	1.272-7.653	0.0129a

^aP < 0.05.

^bP < 0.01.

Stepwise logistic regression considering the following variables: Sex, age class, body mass index class, Charlson Comorbidity Index, discriminant function class, model for end-stage liver disease class. CCI: Charlson Comorbidity Index. MELD-Na: Model for End-Stage Liver Disease with serum sodium concentration.

Table 5 Logistic regression analysis of odds of encounter mechanical ventilation

Attribute	Odds ratio	95%CI	P value
Sex
Female	1.352	1.006-1.816	0.0168a
CCI [Mild (≤ 2) as referent]
Moderate (3-4)	6.717	2.081-21.680	0.0014b
Severe (≥ 5)	13.535	4.221-43.405	< 0.0001b
MELD-Na score (≤ 15 as referent)
16-20	1.223	0.437-3.425	0.7018
21-22	1.349	0.443-4.109	0.5986
23-26	2.139	0.804-5.690	0.1275
27-31	3.074	1.173-8.06	0.0224a
≥ 32	5.392	2.087-13.934	0.0005a

^aP < 0.05.

^bP < 0.01.

Stepwise logistic regression considering the following variables: Sex, age class, body mass index class, Charlson Comorbidity Index discriminant function class, model for end-stage liver disease class. CCI: Charlson Comorbidity Index; MELD-Na: Model for End-Stage Liver Disease with serum sodium concentration.