Harris E, Rhudy C, Roy L, Cloud A, Leyson CD. Sex differences in severity, outcomes, and healthcare utilization in alcohol-associated hepatitis. World J Hepatol 2025; 17(8): 108063 [DOI: 10.4254/wjh.v17.i8.108063]
Corresponding Author of This Article
Elizabeth Harris, MD, Department of Gastroenterology and Hepatology, Marshall University, 1600 Medical Center Drive, Huntington, WV 25701, United States. lizzy4910@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Aug 27, 2025; 17(8): 108063 Published online Aug 27, 2025. doi: 10.4254/wjh.v17.i8.108063
Sex differences in severity, outcomes, and healthcare utilization in alcohol-associated hepatitis
Elizabeth Harris, Christian Rhudy, Lucas Roy, Amber Cloud, Christina Delacruz Leyson
Elizabeth Harris, Department of Gastroenterology and Hepatology, Marshall University, Huntington, WV 25701, United States
Christian Rhudy, College of Pharmacy, University of Kentucky, Lexington, KY 40508, United States
Lucas Roy, Amber Cloud, Internal Medicine Residency Program, University of Kentucky, Lexington, KY 40508, United States
Christina Delacruz Leyson, Division of Digestive Diseases and Nutrition, Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY 40536, United States
Author contributions: Leyson CD, Roy L conceptualized and designed the research study and obtained data; Harris E, Rhudy C, performed initial data analysis; Cloud A, Roy L performed chart review; Rhudy C performed statistical analysis; Harris E wrote the manuscript. All authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved by the University of Kentucky Institutional Review Board (Approval No. 63653).
Informed consent statement: This was a retrospective chart review with no identifiable patient information presented. The patient was exempt from informed consent.
Conflict-of-interest statement: None of the authors have any financial, professional, or personal disclosures.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at (harrise@marshall.edu). Consent was not obtained but the presented data are anonymized and risk of identification is low.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Elizabeth Harris, MD, Department of Gastroenterology and Hepatology, Marshall University, 1600 Medical Center Drive, Huntington, WV 25701, United States. lizzy4910@gmail.com
Received: April 10, 2025 Revised: May 26, 2025 Accepted: July 9, 2025 Published online: August 27, 2025 Processing time: 139 Days and 16.4 Hours
Abstract
BACKGROUND
There is increasing incidence of alcohol-associated liver disease in females. Despite this recent increased incidence, there is a paucity of research on the clinical course and outcomes of alcohol-associated hepatitis (AH) in females compared to males.
AIM
To assess if there may be sex differences in severity, outcomes, and healthcare utilization for patients hospitalized for AH.
METHODS
This study used ICD-9-CM and ICD-10-CM codes to retrospectively identify inpatient encounters for AH at the University of Kentucky from 2012-2021 and obtained data on patient demographics and clinical outcomes. Encounters were cohorted by patient sex and differences in patient demographics and clinical outcomes were assessed. Multivariate logistic regression models were constructed to assess risk of mortality, sepsis, and mechanical ventilation during the encounter.
RESULTS
Of 1386 subjects, 511 (36.9%) were female and 875 (63.1%) were male. Both sexes had similar baseline characteristics of race/ethnicity, discriminant function score, model of end-stage liver disease score, and length of hospital stay. However, the incidence of urinary tract infection, sepsis, and norepinephrine administration was significantly higher for females. Males had a significantly higher incidence of esophageal variceal bleed. On multivariate logistic regression analysis, females had higher odds of encounter sepsis (OR 1.41; 95%CI: 1.064-1.869) and mechanical ventilation (OR 1.352; 95%CI: 1.006-1.816). Odds of encounter mortality were significantly increased in encounters with sepsis (OR 2.309; 95%CI: 1.419-3.757) and mechanical ventilation (OR 9.301; 95%CI: 5.724-15.114).
CONCLUSION
This study shows sex-based differences in AH outcomes at the University of Kentucky. Future studies are warranted to assess whether tailoring treatments will improve clinical outcomes in females with AH.
Core Tip: Females with alcohol-associated hepatitis had higher incidence of urinary tract infection, sepsis, and norepinephrine administration on univariate analysis. On multivariate logistic regression analysis, females had higher odds of sepsis and mechanical ventilation, which were both found to be independent predictors of mortality.
