Diabetes mellitus and decompensated cirrhosis: Risk of hepatic encephalopathy in different age groups (糖尿病与失代偿性肝硬化：不同年龄组的肝性脑病风险)

Butt, Zeeshan; Jadoon, Nauman; Salaria, Osman Nawazish; Mushtaq, Kamran; Riaz, Irbaz Bin; Ahmed, Shahzad; Hashmi, Ali Madeeh; Sarwar, Shahid

doi:10.1111/1753-0407.12067

Cited by 36 publications

(28 citation statements)

References 22 publications

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“…Some cirrhosis patients are known to be at greater risk of HE than others, particularly those with previous episodes, but also those with hyponatremia, poor metabolic liver function [1], or a transjugular intrahepatic portosystemic shunt (TIPS). Diabetes mellitus, too, has been associated with a higher prevalence of HE [2][3][4][5], although this has not been a consistent finding [6]. Moreover, all previous studies addressing this question used a cross-sectional study design, meaning that they could not determine whether diabetes increased the incidence or the duration of HE episodes.…”

Section: Introductionmentioning

confidence: 99%

Diabetes as a risk factor for hepatic encephalopathy in cirrhosis patients

Jepsen

Watson

Andersen

et al. 2015

Journal of Hepatology

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Section: Introductionmentioning

confidence: 99%

Diabetes as a risk factor for hepatic encephalopathy in cirrhosis patients

Jepsen

Watson

Andersen

et al. 2015

Journal of Hepatology

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“…Liu et al reported that the presence DM increased the risk for decompensation events (including HCC) compared to patients with cirrhosis only, [28] a finding supported by other earlier studies. [29–31] In addition, although successful HCV eradication with antiviral therapy reduced HCC risk, [32,33] hyperglycemia, and other unfavorable predictors of antiviral treatment efficacy [34,35] may indirectly promote HCC development. Finally, metabolic syndrome, of which DM is a component, increases the risk of nonalcoholic steatohepatitis (NASH), which can lead to HCC.…”

Section: Discussionmentioning

confidence: 99%

Diabetes mellitus increases the risk of hepatocellular carcinoma in treatment-naïve chronic hepatitis C patients in China

Gao

et al. 2017

Medicine

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We investigated the link between diabetes mellitus (DM) and hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) risk in treatment-naïve chronic hepatitis C (CHC) patients in China.To examine the association between DM and HCC, we conducted a case–control study of 300 Chinese CHC patients with HCC, compared to an age- and sex-matched control group of 517 CHC patients not diagnosed with HCC.We found that DM was more prevalent in the HCC patient group (18.7%) than in the CHC-only patient group (10.8%). We conducted logistic regression analyses adjusting for demographics features and other HCC risk factors and found that DM increased the risk of HCC development nearly 2-fold [adjusted odds ratio (AOR), 95% confidence interval (95% CI), 1.80 (1.17–2.75)]. Meanwhile, the proportion of HCC patients and CHC-only patients with liver cirrhosis were 79.3% and 46.2%, respectively, yielding an AOR of 4.62 (95% CI, 3.31–6.46). Multivariate analyses comparing the risk of HCV-related HCC development in DM patients with and without liver cirrhosis revealed that the estimated AOR (95% CI) for those with liver cirrhosis was 5.60 (2.25–13.96). However, the HCC risk decreased significantly with a later age of diabetes onset (AOR [95% CI], 0.94 [0.89–0.99]).DM was associated with an increased risk for HCC development in treatment-naïve CHC patients in China. Furthermore, liver cirrhosis and an early DM diagnoses further increased the risks of HCC development in patients diagnosed with both CHC and DM.

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“…For cirrhotic patients, the coexistence of DM with cirrhosis might increase the risk of adverse progression and cause severe complications. According to prior studies, increases in orocecal transit time and intestinal bacterial growth due to diabetes may increase blood ammonia levels, which could lead to a high prevalence of HE among cirrhotic patients with diabetes [18] [19]. However, in this study, although univariate analysis indicated that diabetes was significantly associated with the incidence of HE, the association between DM and the presence of HE did not reach statistical significance in multiple logistic regression analysis after adjusting for several other factors, such as age, BMI, WBC, INR, SBP, total bilirubin, ALT, AST, albumin, and PA. SBP is another important complication among cirrhotic patients that requires hospitalization and treatment with antimicrobial agents; this condition can lead to poor quality of life and shortened survival times [18] [20] [21].…”

Section: Discussionmentioning

confidence: 99%

Role of Diabetes Mellitus in Liver Cirrhosis in the Anhui Region of China

Hu¹,

Xu²,

Zhou³

et al. 2015

OALib

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Aims: The aim of this study was to investigate the frequency of diabetes mellitus (DM) among cirrhotic inpatients with different etiologies and the impact of DM on the prognosis of these patients. Methods: A retrospective study of the association between DM and cirrhosis was performed on 672 cirrhotic inpatients at the First Affiliated Hospital of Anhui Medical University from January 1, 2012 to March 1, 2013. Data were assessed using SPSS 20.0. Results: The DM prevalences involving different etiologies were 45.08%, 40.43%, 42.85%, 41.67%, and 25.56% among 672 patients with alcoholic cirrhosis, cryptogenic cirrhosis, schistosomiasis, chronic hepatitis C, and chronic hepatitis B, respectively. Multivariate analysis indicated that relative to non-diabetic patients, patients with DM were older (OR 2.83, 95% CI 2.78 -2.87, p < 0.001), had higher white blood cell levels (OR 3.01, 95% CI 2.83 -3.22, p = 0.001) and were more frequently Child-Pugh class C (OR 1.28, 95% CI 1.14 -1.55, p < 0.001); these differences were also statistically significant in univariate analysis. Univariate analysis suggested that the presence of DM was associated with a higher international normalized ratio (p = 0.013), a higher incidence of hepatic encephalopathy (p = 0.014), and a more frequent incidence of spontaneous bacterial peritonitis (p < 0.001). Conclusion: DM is extremely common among cirrhotic patients and is particularly prevalent among alcoholic cirrhosis patients in the examined region of China. The presence of DM in cirrhotic patients was strongly associated with an elevated Child-Pugh score and an accelerated progression of cirrhosis.

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Diabetes mellitus and decompensated cirrhosis: Risk of hepatic encephalopathy in different age groups (糖尿病与失代偿性肝硬化：不同年龄组的肝性脑病风险)

Abstract: Both DM and older age are independently associated with HE in patients with cirrhosis.

Cited by 36 publications

References 22 publications

Diabetes as a risk factor for hepatic encephalopathy in cirrhosis patients

Diabetes as a risk factor for hepatic encephalopathy in cirrhosis patients

Diabetes mellitus increases the risk of hepatocellular carcinoma in treatment-naïve chronic hepatitis C patients in China

Role of Diabetes Mellitus in Liver Cirrhosis in the Anhui Region of China

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