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Original research
Clinical implications of gender and race in patients admitted with autoimmune hepatitis: updated analysis of US hospitals
  1. David Uihwan Lee1,
  2. Jean Kwon2,
  3. Christina Koo2,
  4. John Han2,
  5. Gregory Hongyuan Fan2,
  6. Daniel Jung3,
  7. Elyse Ann Addonizio2,
  8. Kevin Chang2,
  9. Nathalie Helen Urrunaga1
  1. 1Division of Gastroenterology and Hepatology, University of Maryland Medical Center, Baltimore, Maryland, USA
  2. 2School of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
  3. 3School of Medicin, UMKC School of Medicine, Kansas City, Missouri, USA
  1. Correspondence to Dr David Uihwan Lee, Division of Gastroenterology and Hepatology, University of Maryland Medical Center, Baltimore, Maryland, USA; dvleeman{at}gmail.com

Abstract

Background 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.

Methods 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.

Results 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.

Conclusion Males and minorities are at a greater risk of developing hepatic complications and having increased hospital costs when admitted with AIH.

  • liver
  • ascites
  • encephalopathy
  • liver failure
  • autoimmune hepatitis

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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Footnotes

  • Contributors DL: roles: conceptualisation, data curation, formal analysis, investigation, methodology, supervision, validation, writing-original draft, writing-review and editing, manuscript submission; JK: roles: methodology, writing-original draft, visualisation, writing-review and editing; CK, JH, GHF, DJ, EAA and KC: roles: writing-original draft, investigation; NHU: roles: supervision, writing-review and editing. DUL acted as the guarantor.

  • Funding DL was supported by Grant Number 5 T32 DK 067872-17 from the National Institutes of Health (NIH) National Institute of Diabetes and Digestive and Kidney Diseases.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.