Men With Cirrhosis Face Sharply Higher Risks of Serious Complications

New Study Reveals Significant Sex Disparities in Liver Disease Outcomes

Men diagnosed with cirrhosis face considerably greater odds of developing liver cancer, requiring a transplant, or experiencing liver decompensation compared to their female counterparts, according to groundbreaking research. These findings underscore a critical need to address sex-based inequities in managing this progressive liver condition.

Alarming Risk Escalation for Male Patients

A comprehensive study analyzing data from over 400,000 adult patients revealed that males exhibited more than double the risk of hepatocellular carcinoma (HCC). They also faced a 63% increased likelihood of needing a liver transplant (LT) and a 16% higher chance of developing decompensated cirrhosis (DC).

These sex-driven differences in adverse liver events were particularly pronounced in cases of nonviral cirrhosis, suggesting distinct biological or environmental factors at play.

Expert Calls for Equity in Care

“A firm recognition of the scope and degree of sex-based differences in cirrhosis outcomes is required to begin the important work to address and eliminate these disparities,” stated Jeremy Louissaint, MD, an assistant professor at UT Southwestern Medical Center.

—Jeremy Louissaint, MD, Assistant Professor, UT Southwestern Medical Center

Dr. Louissaint added, “This impactful study is a major step forward toward achieving sex-based equity in cirrhosis outcomes.” His comments were made in an invited commentary accompanying the research.

Understanding the Growing Cirrhosis Epidemic

With cirrhosis prevalence predicted to surge by over 50% by 2030, understanding factors that elevate a patient’s risk for severe outcomes is paramount. Mindie Nguyen, MD, a transplant hepatologist at Stanford University, led the investigation to quantify these sex disparities.

The research team conducted a retrospective cohort study using the Merative MarketScan Research Databases from January 2007 to December 2022. Patients were included if they had at least one inpatient or two outpatient diagnoses of cirrhosis or its complications.

Methodology Ensures Robust Findings

Adverse liver events, including DC, HCC, and LT, were the primary focus. The study meticulously matched nearly 170,000 pairs of male and female patients based on crucial baseline characteristics like age, cirrhosis etiology, and comorbid conditions. This rigorous approach, known as propensity score matching, ensured that the observed differences were reliably attributable to sex.

Key Findings Highlighted

The analysis revealed striking differences in incidence rates per 1000 person-years. Males showed a significantly higher rate for DC (65.77 vs. 55.35), HCC (6.98 vs. 3.35), and LT (10.23 vs. 6.27) compared to females, with all comparisons showing statistically significant differences (P < .001).

In alcohol-related liver disease, male sex presented the highest risk for all adverse events. Similar elevated risks were seen in metabolic dysfunction-associated steatotic liver disease and hepatitis C, though not consistently across all outcomes for hepatitis B infection.

“Considering the shifting etiologies of cirrhosis from viral to nonviral in recent years, future prevention and surveillance strategies for cirrhosis-related complications should incorporate these sex differences,” Dr. Nguyen concluded.