P0935 - Trends of Primary Biliary Cholangitis Among Hospitalized Patients in the United States Between 2011-2020: A Nationwide Cohort Analysis

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

Yazan Abboud, MD

Rutgers New Jersey Medical School
Newark, NJ

Yazan Abboud, MD¹, AbdelKader Chaar, MD², Tarek Aboursheid, MD³, Ayham Khrais, DO¹, Anmol Mittal, MD¹, Nikolaos T.. Pyrsopoulos, MD, PhD, MBA¹
¹Rutgers New Jersey Medical School, Newark, NJ; ²Yale University School of Medicine, New Haven, CT; ³Ascension Saint Francis Hospital, Chicago, IL

Introduction: Primary biliary cholangitis (PBC) is an autoimmune liver disease that results in the progressive destruction of the intrahepatic bile ducts and can lead to liver cirrhosis. There is limited data on PBC trends and outcomes in the US. With the increasing accessibility of PBC medications and the approval of new agents for PBC management, we aimed to investigate recent PBC trends and its outcomes among hospitalized patients in the US.

Methods: We performed a retrospective study using the National Inpatient Sample database between 2011-2020 of all adult hospitalized patients with discharge diagnoses of PBC. The rates of different PBC-related complications were calculated and stratified by sex. Sex-specific time-trends were estimated using Joinpoint Regression Software (v4.9.0.1, NCI), which uses Monte Carlo permutation analysis to generate the simplest segmented line that reflects change of a variable over time. The trends were reported as annual percentage change (APC) and average APC (AAPC).

Results: Between 2011-2020, there were 123,074 hospitalized patients with a diagnosis of PBC. The AAPC of PBC incidence, mortality, and length of stay were stable in men and women (P-values=NS) (Table and Figure). While total charges were stable in men (AAPC=2.28; P=0.18), they were increasing in women (AAPC=2.55; P=0.004). When evaluating complications, while the rate of decompensated cirrhosis was decreasing during the entire period, the rates of decompensated cirrhosis started to decrease in 2015 for men (AAPC=-43.49; P=0.002) and 2014 for women (AAPC=-37.48; P=0.02). On the other hand, the rate of patients with gastroesophageal varices (Men AAPC=2.58; P=0.001, Women AAPC=2.83; P=0.004) and portal hypertension (Men AAPC=2.27; P=0.02, Women AAPC=3.64; P< 0.001) was increasing in both sexes. Lastly, the rates of ascites and Sjogren’s Syndrome, and the total charges have been stable in men (P-values=NS) but increasing in women (AAPC= 3.20, 4.33, and 2.55, respectively, P-values< 0.05).

Discussion: Our nationwide study evaluating recent trends and outcomes of PBC shows that the rates of cirrhosis have been decreasing among patients with PBC over the last years which can reflect the improvement in management modalities. We also show that women with history of PBC have been experiencing increasing rates of ascites, Sjogren’s Syndrome, and total charges, compared to men. Future studies are warranted to investigate risk factors associated with the revealed findings.

Figure: Figure: Trends in Primary Biliary Cholangitis (PBC) related hospitalizations in the US stratified by sex.

Sex	Time-Trends
Sex	Time period	APC (95% CI)	AAPC (95% CI)
Incidence
Men	2011-2020	0.87 (-2.82 to 4.70); P=0.60	0.87 (-2.82 to 4.70); P=0.60
Women	2011-2020	1.24 (-0.15 to 2.64); P=0.07	1.24 (-0.15 to 2.64); P=0.07
Mortality
Men	2011-2020	1.06 (-5.97 to 8.63); P=0.74	1.06 (-5.97 to 8.63); P=0.74
Women	2011-2020	0.52 (-2.23 to 3.35); P=0.67	0.52 (-2.23 to 3.35); P=0.67
Length of Stay
Men	2011-2020	0.15 (-2.60 to 2.97); P=0.91	0.15 (-2.60 to 2.97); P=0.91
Women	2011-2020	0.45 (-0.13 to 1.04); P=0.11	0.45 (-0.13 to 1.04); P=0.11
Total Hospital Charges
Men	2011-2020	2.28 (-1.28 to 5.97); P=0.18	2.28 (-1.28 to 5.97); P=0.18
Women	2011-2020	2.55 (0.77 to 4.37); P=0.004	2.55 (0.77 to 4.37); P=0.004
Compensated Cirrhosis
Men	2011-2015	4.73 (-4.17 to 14.45); P=0.23	-25.66 (-33.13 to -17.35); P< 0.001
Men	2015-2020	-43.49 (-55.54 to -28.17); P=0.002	-25.66 (-33.13 to -17.35); P< 0.001
Women	2011-2014	32.06 (-38.82 to 185.05); P=0.39	-20.09 (-38.72 to 4.19 to -1.66); P=0.09
Women	2014-2020	-37.84 (-56.33 to -11.53); P=0.02	-20.09 (-38.72 to 4.19 to -1.66); P=0.09
Decompensated Cirrhosis
Men	2011-2020	-5.52 (-8.79 to -2.12); P=0.005	-7.74 (-11.14 to -4.22); p< 0.001
Men	2011-2020	-6.48 (-9.73 to -3.12); P=0.002	-4.78 (-19.87 to 13.16); p=0.578
Gastroesophageal Varices
Men	2011-2020	2.58 (0.71 to 4.49); P=0.01	2.58 (0.71 to 4.49); P=0.01
Women	2011-2020	2.83 (1.12 to 4.56); P=0.004	2.83 (1.12 to 4.56); P=0.004
Portal Hypertension
Men	2011-2020	2.27 (0.40 to 4.17); P=0.02	2.27 (0.40 to 4.17); P=0.02
Women	2011-2020	3.64 (2.33 to 4.97); P< 0.001	3.64 (2.33 to 4.97); P< 0.001
Ascites
Men	2011-2018	4.31 (0.55 to 8.20); P=0.03	-0.86 (-4.58 to 3.01); P=0.65
Men	2018-2020	-17.00 (-31.10 to -0.02); P=0.05	-0.86 (-4.58 to 3.01); P=0.65
Women	2011-2020	3.20 (1.83 to 4.59); P< 0.001	3.20 (1.83 to 4.59); P< 0.001
Sjogren’s Syndrome
Men	2011-2020	-1.26 (-13.08 to 12.16); P=0.82	-1.26 (-13.08 to 12.16); P=0.82
Women	2011-2020	4.33 (1.20 to 7.55); P=0.01	4.33 (1.20 to 7.55); P=0.01
Hepatocellular Carcinoma
Men	2011-2020	1.30 (-4.67 to 7.64); P=0.63	1.30 (-4.67 to 7.64); P=0.63
Women	2011-2020	4.99 (-0.21 to 10.47); P=0.05	4.99 (-0.21 to 10.47); P=0.05
Scleroderma
Men	2011-2020	-4.75 (-14.94 to 6.67); P=0.35	-4.75 (-14.94 to 6.67); P=0.35
Women	2011-2020	1.46 (-2.32 to 5.38); P=0.40	1.46 (-2.32 to 5.38); P=0.40

Table: Table: Joinpoint time-trend analysis of Primary Biliary Cholangitis (PBC) and its outcomes among hospitalized patients in the US between 2011-2020 stratified by sex. Trends are reported as annual percentage change (APC) and average APC (AAPC).

Disclosures:

Yazan Abboud indicated no relevant financial relationships.

AbdelKader Chaar indicated no relevant financial relationships.

Tarek Aboursheid indicated no relevant financial relationships.

Ayham Khrais indicated no relevant financial relationships.

Anmol Mittal indicated no relevant financial relationships.

Nikolaos Pyrsopoulos: CytoSorbents – Grant/Research Support. Durect – Grant/Research Support. Gilead – Grant/Research Support. Grifols – Grant/Research Support. Mallinckrodt Pharmaceuticals – Consultant. Ocelot Bio – Grant/Research Support. Salix – Grant/Research Support.

Yazan Abboud, MD¹, AbdelKader Chaar, MD², Tarek Aboursheid, MD³, Ayham Khrais, DO¹, Anmol Mittal, MD¹, Nikolaos T.. Pyrsopoulos, MD, PhD, MBA¹. P0935 - Trends of Primary Biliary Cholangitis Among Hospitalized Patients in the United States Between 2011-2020: A Nationwide Cohort Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.