Effects of diabetes on the rebleeding rate following endoscopic treatment in patients with liver cirrhosis

Abstract

In the present study, the effects of diabetes on rebleeding following endoscopic treatment were assessed in patients with liver cirrhosis. A retrospective analysis of patients who underwent endoscopic variceal ligation (EVL) or endoscopic injection sclerotherapy (EIS) at the First Affiliated Hospital of Anhui Medical University (Hefei, China) between June 2015 and March 2018 was performed. The patients were divided into the EVL and the EIS groups and each group was subdivided into diabetic and non-diabetic groups. The post-operative rebleeding rate was compared between the EVL and the EIS groups and between the diabetic and non-diabetic patients. The differences in the post-operative rebleeding rate of diabetic patients with hepatogenic and non-hepatogenic diabetes and in patients with different liver function grades were also determined. In the total patient cohort, the rebleeding rate in the EVL subgroup (11.3, 16.5 and 23.5%) was not significantly different compared with that in the EIS subgroup (9.8, 17.4 and 29.3%) at 1, 3 and 6 months following surgery, respectively (P=0.724, 0.868 and 0.339). In the total diabetic group, the rebleeding rate in the EVL subgroup (25.0, 36.1 and 44.4%) was not significantly different compared with that in the EIS subgroup (20.6, 32.4 and 47.1%) at 1, 3 and 6 months following surgery (P=0.660, 0.741 and 0.826, respectively). In the EVL group, the rebleeding rate in the diabetic subgroup (25.0, 36.1 and 44.4%) was higher than that in the non-diabetic subgroup (5.1, 7.6 and 13.9%) at 1, 3, and 6 months following surgery and the differences were significant (P=0.005, <0.001 and <0.001, respectively). In the EIS group, the rebleeding rate in the diabetic subgroup (20.6, 32.4 and 47.1%) was significantly higher than that in the non-diabetic subgroup (3.4, 8.6 and 19.0%) at 1, 3 and 6 months following surgery (P=0.021, 0.004 and 0.004, respectively). Adjustment for age and liver function grade in the EVL and EIS groups was performed using binary logistic regression and the parameter diabetes was indicated to be a risk factor for post-operative rebleeding (P<0.05). No significant difference was noted in the rate of rebleeding between patients with hepatogenic diabetes and non-hepatogenic diabetes at 1, 3 and 6 months following surgery (P=0.634, 0.726 and 0.446, respectively). In the total diabetic group, the rebleeding rate in the Child-Pugh grade A subgroup (14.3, 17.9 and 25.0%) was lower than that in the Child-Pugh grade B/C subgroup (28.6, 45.2 and 59.5%) at 1, 3 and 6 months following surgery, respectively. No significant difference was noted between the two groups at 1 month following surgery (P=0.163). However, the differences were significant at 3 and 6 months following surgery (P=0.018 and 0.005, respectively). The results suggested that diabetes is a risk factor for post-operative rebleeding in patients with cirrhosis. Diabetic patients with poor liver function were more likely to bleed following surgery and the post-operative bleeding rate was not significantly diffe...

Hepatogenic diabetes—current status of diagnostics and treatment

“…Daher erfordert die Diagnose dieser Erkrankung häufig einen oGTT [6,7,9,59]. Derzeit laufen Studien zur Identifizierung genetischer und biochemischer Marker, die eine genauere Unterscheidung zwischen den beiden Arten von DM ermöglichen sollen [62,63].…”

Clinical implications of diabetes in chronic liver disease: Diagnosis, outcomes and management, current and future perspectives

“…Postprandial hyper-glycaemia had a significant association with VH within 6 mo[ 64 ]. In another study, DM was a risk factor for rebleeding following endoscopic variceal ligation[ 65 ]. In a retrospective study, DM was also an independent predictor of in-hospital death in LC patients with acute gastro-intestinal bleeding[ 66 ].…”

Hepatogenous diabetes: Knowledge, evidence, and skepticism

“…In studies where prevalence of HD was specifically looked at using OGTT, the rates ranged from 21% to 57% (Table 2 ). Wang et al [ 22 ] and Ramachandran et al [ 23 ] reported HD prevalence rates of 15.9% and 29.2%, respectively, based on clinical history alone, i.e. , onset of DM after diagnosis of LC.…”

“…Chronic hyperglycemia may induce splanchnic hyperemia in LC patients leading to an increased portal pressure and risk of VH[ 22 , 29 , 104 ]. In a prospective study ( n = 194), HD (55.4%) was significantly associated with increased portal pressure and risk of VH[ 29 ].…”

“…Yang et al [ 104 ] also reported DM as an independent predictor of VH in LC patients (OR = 2.99). Wang et al [ 22 ] have reported an increased risk of rebleeding following endoscopic variceal ligation in HD patients (44% vs 13.9% in 6 mo). DM also increases the mortality risk following upper gastrointestinal bleeding in LC patients (OR = 5.7)[ 105 ].…”