Binu V John1, Gabriella Aitcheson2, Kaley B Schwartz1, Nidah S Khakoo2, Bassam Dahman3, Yangyang Deng3, David Goldberg4, Paul Martin4, Tamar H Taddei5,6, Cynthia Levy4, David E Kaplan7,8. 1. Division of Hepatology, Bruce W Carter VA Medical Center, Miami, FL, USA. 2. Department of Medicine, Jackson Memorial Hospital, Miami, FL, USA. 3. Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA. 4. Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, Miami, FL, USA. 5. Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA. 6. Division of Gastroenterology and Hepatology, VA Connecticut Healthcare System, West Haven, CT, USA. 7. Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA. 8. Division of Gastroenterology and Hepatology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
Abstract
BACKGROUND AND AIMS: The impact of sex on the postcirrhosis progression of primary biliary cholangitis (PBC) has not been well defined. Prior studies have suggested that men have worse outcomes but present at more advanced stages of fibrosis than women. This observation, however, has been limited by small numbers of men and even fewer patients with cirrhosis. APPROACH AND RESULTS: We investigated the association of sex with the development of all-cause and liver-related mortality or transplantation, decompensation, and hepatocellular carcinoma (HCC), using competing-risk time-updating Cox proportional hazards models in a large cohort of predominantly male patients with PBC cirrhosis assembled from the Veterans Health Administration. In a cohort of 532 participants (418 male) with PBC-related cirrhosis with a total follow-up of 3,231.6 person-years (PY) from diagnosis of compensated cirrhosis, male participants had a higher unadjusted rates of death or transplantation (8.5 vs. 3.8 per 100 PY; P < 0.0001), liver-related death or transplantation (5.5 vs. 2.7 per 100 PY; P < 0.0001), decompensation (5.5 vs. 4.0 per 100 PY; P = 0.002), and HCC (0.9 vs. 0.3 per 100 PY; P < 0.0001). After adjusting for confounders, male sex was associated with a higher risk of death or transplantation (adjusted hazard ratio, 1.80; 95% CI, 1.01-3.19; P = 0.046), and liver-related death or transplantation (subhazard ratio, 2.17; 95% CI, 1.15-4.08; P = 0.02). A sensitivity analysis that defined ursodeoxycholic acid response as normalization of alkaline phosphatase and total bilirubin revealed similar findings. CONCLUSIONS: In patients with PBC and well-compensated cirrhosis, male sex is associated with a higher risk of both death and liver-related death or transplantation.
BACKGROUND AND AIMS: The impact of sex on the postcirrhosis progression of primary biliary cholangitis (PBC) has not been well defined. Prior studies have suggested that men have worse outcomes but present at more advanced stages of fibrosis than women. This observation, however, has been limited by small numbers of men and even fewer patients with cirrhosis. APPROACH AND RESULTS: We investigated the association of sex with the development of all-cause and liver-related mortality or transplantation, decompensation, and hepatocellular carcinoma (HCC), using competing-risk time-updating Cox proportional hazards models in a large cohort of predominantly male patients with PBC cirrhosis assembled from the Veterans Health Administration. In a cohort of 532 participants (418 male) with PBC-related cirrhosis with a total follow-up of 3,231.6 person-years (PY) from diagnosis of compensated cirrhosis, male participants had a higher unadjusted rates of death or transplantation (8.5 vs. 3.8 per 100 PY; P < 0.0001), liver-related death or transplantation (5.5 vs. 2.7 per 100 PY; P < 0.0001), decompensation (5.5 vs. 4.0 per 100 PY; P = 0.002), and HCC (0.9 vs. 0.3 per 100 PY; P < 0.0001). After adjusting for confounders, male sex was associated with a higher risk of death or transplantation (adjusted hazard ratio, 1.80; 95% CI, 1.01-3.19; P = 0.046), and liver-related death or transplantation (subhazard ratio, 2.17; 95% CI, 1.15-4.08; P = 0.02). A sensitivity analysis that defined ursodeoxycholic acid response as normalization of alkaline phosphatase and total bilirubin revealed similar findings. CONCLUSIONS: In patients with PBC and well-compensated cirrhosis, male sex is associated with a higher risk of both death and liver-related death or transplantation.
Authors: Binu V John; Bassam Dahman; Yangyang Deng; Nidah S Khakoo; Tamar H Taddei; David E Kaplan; Cynthia Levy Journal: Liver Int Date: 2021-10-12 Impact factor: 5.828
Authors: Binu V John; Yangyang Deng; Paul Martin; Cynthia Levy; Tamar H Taddei; David E Kaplan; Bassam Dahman Journal: Hepatology Date: 2021-08-15 Impact factor: 17.298
Authors: Nadim Mahmud; Sara Chapin; David S Goldberg; K Rajender Reddy; Tamar H Taddei; David E Kaplan Journal: J Hepatol Date: 2022-01-21 Impact factor: 30.083
Authors: Binu V John; Yangyang Deng; Kaley B Schwartz; Tamar H Taddei; David E Kaplan; Paul Martin; Hann-Hsiang Chao; Bassam Dahman Journal: Hepatology Date: 2022-02-22 Impact factor: 17.298
Authors: Binu V John; Raphaella D Ferreira; Akash Doshi; David E Kaplan; Tamar H Taddei; Seth A Spector; Elizabeth Paulus; Yangyang Deng; Dustin Bastaich; Bassam Dahman Journal: J Hepatol Date: 2022-09-28 Impact factor: 30.083