Association between diabetes mellitus and hepatic encephalopathy in patients with cirrhosis

Abstract

Background: Diabetes mellitus may lead to increased serum ammonia and systemic inflammation thereby promoting hepatic encephalopathy (HE). Aim: To investigate the potential association between diabetes mellitus/glycaemic control and the presence of covert HE as well as the development of overt HE in a prospective setting. Methods: A total of 240 patients with liver cirrhosis were included into this prospective cohort study and followed for a median of 17 months. Covert HE was diagnosed by pathological results in the Portosystemic Hepatic Encephalopathy Score. Predictors for the presence of covert HE or the development of overt HE were analysed using logistic regression or Cox-regression models. Results: At study inclusion, 65 patients (27.1%) presented with diabetes mellitus and covert HE was detected in 33.3%. Patients with diabetes mellitus had a more preserved liver function as compared to patients without diabetes mellitus (MELD 9 vs 10; P = 0.043). In regression analyses after adjustment for confounders, diabetes mellitus was independently associated with the presence of covert HE at study inclusion and the development of overt HE during follow-up. These associations were confirmed in separate propensity-score-weighted regression models. In subgroup analyses, patients with worse glycaemic control (HbA1c >= 6.5%) had a pronounced risk for covert HE (OR 2.264, 95% CI 1.002-5.118) and overt HE (HR 4.116, 95% CI 1.791-9.459). Conclusions: Diabetes mellitus may associate with higher risk for the presence of covert HE and the development of overt HE in patients with liver cirrhosis. Adequate glycaemic control may be a potential target to attenuate this important complication. How to cite this article: Labenz C, Nagel M, Kremer WM, et al. Association between diabetes mellitus and hepatic encephalopathy in patients with cirrhosis.

Letter: diabetes mellitus increases the risk of hepatic encephalopathy in patients with cirrhosis—authors’ reply

“…We thank Liu and colleagues for their important comment on our recent manuscript demonstrating an independent effect of diabetes mellitus on the presence of covert hepatic encephalopathy (CHE) and the development of overt hepatic encephalopathy (OHE) in patients with cirrhosis 1 . Liu et al validated our findings by performing a systematic literature search with pooled analysis of studies on diabetes mellitus and the risk of hepatic encephalopathy (HE) 2 .…”

“…Although some modifiable factors to decrease the risk of HE have been recently described, there is still an urgent need to improve the quality of care in the management of patients with cirrhosis and this important complication 7 . As more exhaustively described in our study, diabetes mellitus and, more specifically, poor glycaemic control may be a target to potentially improve cognitive function and prevent development of OHE 1 . Although the demonstrated association seems comprehensible from a pathophysiological point of view, our findings regarding the impact of poor glycaemic control on the risk of HE have to be validated in future multi‐centre studies.…”

Recompensation factors for patients with decompensated cirrhosis: a multicentre retrospective case–control study

“…Diabetes may be related to an increased risk for the existence of covert hepatic encephalopathy and the development of overt hepatic encephalopathy in patients with liver cirrhosis. 40 Uncontrolled diabetes is associated with an increased risk of infection, an enhanced propensity for renal insufficiency, and a variety of other related complications. 41 Diabetes increases the risk of rehospitalisation within 30 or 90 days for patients with decompensated cirrhosis.…”

Letter: diabetes mellitus increases the risk of hepatic encephalopathy in patients with cirrhosis

“…We read with interest the recent article by Labenz et al 1 They found that diabetes mellitus may increase the risk of hepatic encephalopathy (HE) in patients with cirrhosis. 1 Several epidemiological studies also reached the same conclusion. [2][3][4][5][6][7][8] However, other studies displayed different perspectives.…”

“…We included seven studies. [1][2][3][4][5]9,10 Two were from China, 3,5 two were from Germany, 1,4 and the other three were from Denmark, USA and India. 2,9,10 The prevalence of HE was 16.3% (3485/21 369) in cirrhosis patients with diabetes mellitus and 13.6% (7352/54 109) in those without.…”