Male sex is associated with worse outcomes in Primary Biliary Cholangitis

Background and Aims: Although Primary Biliary Cholangitis (PBC) predominantly effects women, limited evidence suggests men experience worse outcomes.

Aims: The aims of this study were to assess sex related differences in outcomes in PBC, and to determine whether these differences are more specific to PBC compared to other causes of cirrhosis.

Method: This was a retrospective study conducted at the Charité Berlin. Inpatient admissions with a documented diagnosis of PBC based off the ICD-10 codes were extracted from 2011-2022. Further information such as age, sex, comorbidities, inpatient complications, procedures, blood test results and in-hospital mortality were obtained. The primary outcome was a composite of in-hospital mortality or liver transplant. Secondary outcomes included in-hospital mortality, liver transplant, decompensated cirrhosis, and length of hospital admission. Uni- and multivariable logistic and linear regression was used to assess the impact of sex on outcomes in PBC. A control group of patients with alternate cirrhosis aetiologies, matched on age and comorbidities on a 1:1 ratio, was compared against, and an interaction term for sex and PBC was included in the modelling.

Results: 940 patient admissions with PBC were obtained, with 82% being female. Men with PBC had higher rates of most acute and chronic complications of liver disease, and significantly higher ALT, AST, GGT, ALP, Bilirubin and INR levels. Women had a reduced odds of the primary outcome on univariable analysis (OR=0.23, 95% CI:[0.14, 0.40], p<0.001) and following adjustment for age and comorbidities (OR=0.27, 95% CI:[0.15, 0.49], p<0.001). This was in contrast to the control group, where female sex was associated with an increased odds of death or transplant on univariable (OR=1.54, 95% CI:[1.02, 2.30], p=0.036) and multivariable (OR=1.58, 95% CI:[1.04, 2.39], p=0.030) logistic regression. The interaction analysis across the combined cohort revealed a modification effect of PBC on the risk of the primary outcome by sex (OR for interaction=0.15, 95% CI:[0.08, 0.30], p<0.001). Similar findings were noted in the assessment of secondary outcomes.

Conclusion: Men with PBC experience worse outcomes across a spectrum of measures. This difference appears to be more specific to PBC compared to other causes of cirrhosis, suggesting the pathological progression of PBC in males may be more severe than in females. Further research is required to consolidate these findings.

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Artikel online veröffentlicht:
26. September 2024