The impact of male sex on outcomes in primary biliary cholangitis

Limited evidence suggests men with Primary Biliary Cholangitis (PBC) experience worse outcomes than women. The aims of this study were to assess sex-related differences in outcomes in PBC, and to determine whether differences were more specific to PBC than other cirrhosis aetiologies. This study conducted at Charité Berlin analysed inpatient admissions from 2011 to 2022 with PBC. The primary outcome was a composite of inpatient mortality or liver transplant. Secondary outcomes included inpatient mortality, liver transplant, decompensated cirrhosis, and hospitalisation duration. Univariable and multivariable logistic and linear regression assessed the impact of sex on outcomes. This was compared to a control group of cirrhosis patients, matched on age and co-morbidities on a 1:1 ratio. 18% of the 940 inpatient admissions with PBC were male. Men had higher rates of liver-related complications, were younger than women, and had more deranged liver function tests. Men had an increased odds of the primary outcome on univariable analysis (OR = 4.28, 95% CI: [2.52–7.23], p < 0.001) and following adjustment for age and comorbidities (OR = 3.68, 95% CI: [2.06–6.58], p < 0.001). This contrasted with the control group, where men had a reduced odds of death or transplant on univariable (OR = 0.65, 95% CI: [0.44–0.98], p = 0.036) and multivariable (OR = 0.63, 95% CI: [0.42–0.96], p = 0.030) regression. Interaction analysis across the combined cohort revealed a modification effect of PBC on the risk of the primary outcome by sex (OR = 6.59, 95% CI: [3.39–12.75], p < 0.001). Similar findings were noted for secondary outcomes. Men with PBC may experience worse outcomes than women. Similar differences are not apparent for other cirrhosis aetiologies.