Esophageal Variceal Bleeding Mortality Risk Lower in Women vs Men

Older female patient in hospital bed.
Older female patient in hospital bed.
Researchers sought to evaluate the effect of a patient’s sex on esophageal variceal bleeding outcomes in the United States.

Women hospitalized with esophageal variceal bleeding have a lower risk for death compared with men, according to study results published in Annals of Medicine.

Researchers conducted a retrospective observational cohort study using data from the National Inpatient Sample (NIS) to identify patients with a discharge diagnosis of esophageal varices with hemorrhage from 2016 to 2019. Patients who were admitted electively, missing mortality data, gender data, or demographic data were excluded from the study.

A total of 166,760 patients (women, 32.7%; White, 67.1%) met inclusion criteria. The mean age of women and men was 58.45±0.13 and 55.65±0.09 years, respectively. The primary outcome was the inpatient mortality from esophageal variceal bleeding as compared between men and women. Secondary outcomes assessed rate of endoscopy, acute kidney injury, blood transfusion, sepsis, intensive care unit admission, and transjugular intrahepatic portosystemic shunt (TIPS).

Researchers found that in-hospital mortality was higher in men vs women (9.91% vs 8.31%; adjusted odds ratio [aOR], 0.88, P =.008). Researchers also noted there was no difference in the odds of undergoing an esophagogastroduodenoscopy, the length of stay, or total hospitalization charges between men and women. However, compared with men, women had lower odds of receiving TIPS (aOR, 0.83; P =.002).

Study limitations include the lack of objective and pharmacological therapy data in the NIS, which are important confounders that may affect patient outcomes. Further, the researchers were only able to obtain documentation of acute episodes of esophageal variceal bleeding from the NIS, so data on patient readmissions was not obtained and researchers were unable to follow patients longitudinally.

“This study reveals that prognosis depends not only on the etiology and complications of liver disease but also on gender,” the researchers concluded. “Further research is needed to elucidate the factors responsible for the reduced mortality in female patients. The development of gender-specific management programs would help target the needs of women and men living with cirrhosis.”


Sohal A, Chaudhry H, Dhaliwal A, et al. Gender differences in esophageal variceal bleeding in the United States. Ann Med. 2022;54(1):2115-2122. doi:10.1080/07853890.2022.2104920