E0471 - Females Are at Lower Risk of Mortality as Compared to Males When Admitted for Esophageal Variceal Bleeding: A National Inpatient Sample Analysis

Introduction: The natural history of liver disease differs by gender. Women are significantly less likely to have chronic liver disease, with men accounting for 55–70% of the total cases. Women are thought to have a more favorable clinical course however the effect of gender on outcomes in patients with esophageal variceal bleeding is unknown. In this study, we analyze the effects of gender differences on outcomes in patients with esophageal variceal bleeding in the US.

Methods: The National Inpatient Sample (NIS) database was used to identify patients with a discharge diagnosis of esophageal varices with hemorrhage from 2016 to 2019. The relationship between gender and in-hospital mortality, endoscopy requirement, acute kidney injury (AKI), blood transfusion requirement, sepsis, ICU admission, placement of transjugular intrahepatic portosystemic shunt (TIPS), total hospitalization charge, and length of stay was analyzed using multivariate logistic regression. We adjusted for patient demographics, hospital characteristics, hepatic decompensations, and common etiologies of liver disease.

Results: We identified a total of 166,760 patients with variceal bleeding of which 32.7% were female. A complete list of patient characteristics is presented in Table 1. The risk of mortality rate in females was higher than males (aOR:0.88, p=0.005). There were no statistical differences between males and females in terms of length of stay (-0.001 days, p=0.982), hospitalization cost, and charge (-$2,332.25, p=0.214, and -$520.99, p=0.249, respectively). Females also had decreased risk of AKI (aOR:0.78, p< 0.001), ICU admission (aOR=0.84 p< 0.001) and TIPS (aOR=0.83 p=0.002). There was no statistically significant difference in the rates of endoscopy (aOR=1.01 p=0.30) and blood transfusion requirement (aOR=1.03 p=0.299) between the two groups. Outcomes stratified by gender are stratified in Table 1.

Discussion: Women hospitalized with esophageal variceal bleeding are at a lower risk of death compared to males. Our study also highlights decreased disease severity in females as evidenced by lower rates of AKI, ICU admission and TIPS. Further research is needed to elucidate the factors affecting the outcomes, such as the role of estrogen, in patients admitted with acute variceal bleeding.