Gender and Racial Disparities in the Impact of Factor V Leiden on Mortality and Venous Thromboembolic Outcomes Among Patients with Liver Cirrhosis: A National Inpatient Sample Analysis
Authors: Saowapa Sakditad , Polpichai Natchaya , Bernal Diego Olavarria , Garcia Pleitez Hector , Kanitthamniyom Chanakarn , Danpanichkul Pojsakorn , Wannaphut Chalothorn , Tanariyakul Manasawee , Wattanachayakul Phuuwadith , Suenghataiphorn Thanathip , Kulthamrongsri Narathorn , Ponvilawan Ben , Siladech Pharit , Tijani Lukman 
Published: December 2024

Introduction : Liver cirrhosis presents a complex hemostatic profile, predisposing patients to both bleeding and thrombotic events. The Factor V Leiden (FVL) mutation is a known risk factor for venous thromboembolism (VTE) and may influence mortality in these patients. This study investigates gender and racial disparities in the impact of FVL on mortality and VTE outcomes among cirrhosis patients.

Method : A retrospective analysis of National Inpatient Sample (NIS) data from 2016 to 2020 identified adults with cirrhosis using International Classification of Diseases, Tenth Revision (ICD-10) codes, categorizing them by the presence of FVL or activated protein C resistance using code D68.51. The primary outcome was in-hospital mortality, while secondary outcomes included VTE events such as pulmonary embolism (PE) and acute deep vein thrombosis (DVT) of the lower (LE) and upper extremities (UE). Multivariable logistic regression models were utilized to adjust for potential confounders and to assess the impact of gender and race on clinical outcomes between these cohorts, with p-values ≤ 0.05 indicating statistical significance. Males and Caucasian were used as reference categories.

Result : The study cohort consisted of 3,667,019 adult patients with cirrhosis, including 5,145 patients with FVL, of whom 53.99% were male and 46.01% were female. Racial composition was 66.33% Caucasian, 16.60% Hispanic, 10.45% African American, and 6.62% other races. After adjustment for confounders, females with cirrhosis and FVL exhibited significantly lower mortality (adjusted odds ratio (aOR) = 0.91; P&lt;0.001), PE (aOR = 0.88; P&lt;0.001), and acute DVT of LE (aOR = 0.91; P&lt;0.001) compared to males. Compared to White patients, other races, Asian/Pacific Islander, and African American patients demonstrated a higher risk of mortality, with aORs of 1.19 (P&lt;0.001), 1.11 (P=0.001), and 1.06 (P=0.001), respectively. Hispanic patients demonstrated a lower risk of mortality with an aOR of 0.87 (P&lt;0.001). African American patients had a higher risk of PE (aOR = 1.40; P&lt;0.001), whereas Hispanic, Asian/Pacific Islander, and Native American patients had lower risks with aORs of 0.66, 0.65, and 0.70 (all P&lt;0.01), respectively. Similarly, African American patients showed significantly higher odds of acute DVT of LE (aOR = 1.24; P&lt;0.001) compared to Caucasian patients, while Hispanic, Asian/Pacific Islander, and Native American patients had lower risks. Additionally, Black patients faced a higher risk of acute DVT of UE (aOR = 1.46; P&lt;0.001).

Discussion: This study revealed significant gender and racial disparities in mortality and VTE outcomes among patients with cirrhosis and FVL. Women with these conditions experienced notably better outcomes than men. Racial disparities were particularly pronounced, with Asian/Pacific Islander, and African American patients facing higher mortality compared to Caucasian patients. African American patients faced a higher risk of acute VTE, indicating a critical need for targeted interventions and deeper exploration into the social determinants affecting these health disparities.