Clinical features and prognosis of autoimmune hepatitis patients with different sexes

ObjectiveTo investigate the differences between autoimmune hepatitis (AIH) patients with different sexes, since AIH is more common in female individuals and there are few studies on male AIH patients. MethodsA retrospective analysis was performed for 398 patients who were hospitalized in Beijing YouAn Hospital from October 2009 to October 2019 and were diagnosed with AIH, and the patients were divided into female group and male group according to sex. General status, clinical features, and prognosis were analyzed. The primary outcome measure was death or liver transplantation. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. The Cox proportional hazards model was used to perform univariate and multivariate analyses. ResultsAs for age, the peak of disease onset was observed in patients aged 51-60 years in both male and female groups, and compared with the female group, the male group had a significantly higher rate of confirmed diagnosis at the age of 21-30 years (8/48 vs 24/334, χ2=4.915, P=0.027) and a significantly lower rate of confirmed diagnosis at the age of 41-50 years (7/48 vs 97/334, χ2=4.428, P=0.035). As for AIH, compared with the female group, the male group had a significantly higher proportion of patients with idiopathic AIH (31/48 vs 170/350, χ2=4.329, P=0.037) and a significantly lower proportion of patients with other autoimmune diseases, especially hyperthyroidism (0/48 vs 39/348, P=0.008). As for laboratory examination, compared with the female group, the male group had significantly lower positive rates of anti-nuclear antibody (ANA)≥1∶100(42/48 vs 325/340, χ2=5.375, P=0.020) and SSA/SSB (2/48 vs 76/340, χ2=7.566, P=0.006), as well as a significantly lower proportion of patients with ANA ≥1∶1000 (P＜0.000 1). As for prognosis, compared with the female group, the male group had a significantly younger age at the time of death or liver transplantation (31.5±15.9 years vs 53.9±12.6 years, t=3.798, P=0.001) and a significantly higher proportion of patients with decompensated liver cirrhosis or hepatocellular carcinoma (both P＜0.05). Diabetes, liver cirrhosis, and blood albumin ＜31.4 g/L were high-risk factors for reduced survival time in male patients, and liver failure, liver cirrhosis, ANA ≥1∶1000, direct bilirubin ＞42 μmol/L, lymphocyte count ＜1.2×109/L, and C3 ＜0.588 g/L were high-risk factors for reduced survival time in female patients. ConclusionSex difference has certain influence on the clinical manifestations and prognosis of AIH patients, and male patients tend to have a younger age and a poorer prognosis