Sex-specific differences in the clinical and psychiatric phenotype of hospitalized patients admitted to a tertiary alcohol-related disease unit

Background and aims Alcohol use disorder (AUD) is a mental disorder that affects up to 10.7% of the European population. There is historically a higher prevalence in male patients. Despite evidence supporting sex-related differences in AUD patients, to date, research has focused predominantly on patients of male sex. Methods We conducted a retrospective analysis of 907 patients (Females n 238, 26.2%) with AUD admitted to a tertiary Alcohol-related Disease Unit between 2004 and 2022. We collected demographics and clinical manifestations associated with AUD, including psychiatric disorders and alcohol withdrawal syndrome (AWS). Results Male and female patients showed similar prevalences of atrial fibrillation, ischemic cardiomyopathy, alcohol-related cognitive impairment, and AWS severity, whereas psychiatric disorders, particularly depressive disorders, eating disorders, and personality disorders, were significantly more frequent in female patients. Mild AWS was independently associated with increased long-term mortality (HR 1.625, 95% CI 1.041–2.536, p = 0.033). Sex-stratified analyses showed that age and neurovascular disease were independent predictors of mortality in male patients, whereas pulmonary and gastrointestinal diseases were independent predictors of mortality in female patients. Discussion and Future directions These findings support the presence of sex-related differences in the clinical and prognostic profile of patients with AUD, despite a similar distribution of AWS severity. Our results support the integration of sex-specific risk stratification and comprehensive multidisciplinary management, with particular attention to mental health and systemic comorbidities to improve long-term outcomes.