Published online Feb 28, 2019. doi: 10.3748/wjg.v25.i8.980
Peer-review started: November 12, 2018
First decision: January 6, 2019
Revised: January 13, 2019
Accepted: January 18, 2019
Article in press: January 18, 2019
Published online: February 28, 2019
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% vs 43%; P = 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; P = 0.03], which remained significant on adjusted multivariable analysis (OR 1.6, 95%CI: 1.1-2.6; P = 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.
Core tip: In this single-center study of patients on the liver transplant waitlist, women were significantly more likely to be hospitalized than men, and were hospitalized for a more days within one year. Among those who were hospitalized at least once, there was a trend toward higher rates of readmission among women compared to men. These gender differences were independent of underlying severity of illness, as measured by model for end- stage liver disease score, suggesting that perhaps traditional indicators of liver disease severity do not adequately capture all contributors to illness, such as non-hepatic comorbidities or socioeconomic factors, which may require acute inpatient care.