Uncontrolled diabetes mellitus increases risk of infection in patients with advanced cirrhosis

Rosenblatt, Russell; Atteberry, Preston; Tafesh, Zaid H.; Ravikumar, Aarti; Crawford, Carl V.; Lucero, Catherine; Jesudian, Arun; Brown, Robert S.; Kumar, Sonal; Fortune, Brett E.

doi:10.1016/j.dld.2020.10.022

Cited by 14 publications

(9 citation statements)

References 46 publications

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“…The presence of multiple infections was more common in patients with uncontrolled vs. controlled DM (9.0% vs. 6.3%, p < 0.001), urinary tract infections (UTI), pneumonia, cellulitis, and sepsis being the most prevalent (all p < 0.001). There was no significant relationship between uncontrolled DM and SBP, Clostridium difficile infection or cholangitis individually (all p > 0.20) [ 33 ].…”

Section: Resultsmentioning

confidence: 99%

“…Overall, patients with DM experienced higher incidence of SBP, especially those with HbA1c values ≥6.4% [ 29 ]. Uncontrolled DM was associated with increased risk of multiple bacterial infections (UTI, pneumonia, cellulitis, and sepsis being the most prevalent) [ 33 ], proving that tight glycemic control could lower the risk for developing infections in cirrhotic patients with DM. However, considering the small number of studies and the contradictory findings, future research regarding the risk of infections in patients with DM and LC is needed.…”

Section: Discussionmentioning

confidence: 99%

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Association between Liver Cirrhosis and Diabetes Mellitus: A Review on Hepatic Outcomes

Coman

Bădărău

et al. 2021

JCM

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Background: Liver cirrhosis (LC) is largely associated with diabetes mellitus (DM). More than 80% of patients with LC manifest glucose intolerance and about 30% have type 2 DM. A particular and yet unrecognized entity is hepatogenous diabetes (HD), defined as impaired glucose regulation caused by altered liver function following LC. Numerous studies have shown that DM could negatively influence liver-related outcomes. Aim: We aimed to investigate whether patients with LC and DM are at higher risk for hepatic encephalopathy (HE), variceal hemorrhage (VH), infections and hepatocellular carcinoma (HCC). The impact of DM on liver transplant (LT) outcomes was also addressed. Methods: Literature search was performed in PubMed, Ovid, and Elsevier databases. Population-based observational studies reporting liver outcomes in patients with LC were included. Results: Diabetics are at higher risk for HE, including post-transjugular intrahepatic portosystemic shunt HE. DM also increases the risk of VH and contributes to elevated portal pressure and variceal re-bleeding, while uncontrolled DM is associated with increased risk of bacterial infections. DM also increases the risk of HCC and contributes to adverse LT outcomes. Conclusions: Patients with DM and LC may benefit from close follow-up in order to reduce readmissions and mortality. Due to the heterogeneity of available research, prospective multicenter clinical trials are needed to further validate these findings.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association between Liver Cirrhosis and Diabetes Mellitus: A Review on Hepatic Outcomes

Coman

Bădărău

et al. 2021

JCM

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“…Hepatic brosis, the increased deposition of extracellular matrix (ECM) protein, is a major cause of chronic liver injury [23] and T2DM potentiates liver in ammation and ultimate severe liver failure in addition to the prevalence of bacterial infections [24]. The in ammation along with oxidative stress causes chronic hyperglycemic injuries and lipid disorder in hepatic tissues [25]. Persistent hepatic brosis can lead to liver cirrhosis and ultimately to organ failure and death.…”

Section: Discussionmentioning

confidence: 99%

Effect of heterologous platelet-rich plasma (PRP) on liver and modulation of glucose metabolism and Wnt signaling pathways in diabetic mice

Arif

Farooq

Abbasi

et al. 2022

Preprint

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Platelet-rich plasma (PRP) is proven a cost-effective therapeutic choice for different ailments. The current study was designed to highlight the effects of heterologous platelet-rich plasma (PRP) on deteriorated hepatic tissues and impaired glucose metabolism in alloxan-induced diabetic mice. A total of thirty (30) male mice were selected and grouped as control (CG), PRP group (PG), diabetic group (DG), treated group 1 (T1G), and treated group 2 (T2G). PG was given a subcutaneous dose of PRP (0.5 ml/kg body weight) twice a week for four weeks. DG, T1G, and T2G were first given a single dose of alloxan intraperitoneally (150 mg/kg) to induce diabetes. PRP (0.5 ml/kg body weight) was given twice a week to T1G and T2G for two and four weeks respectively. After four weeks, all the mice were sacrificed to excise liver for histological observations and gene expression analysis. Hepatic histo-morphological analysis revealed ballooning of hepatocytes, dilatation of sinusoids, and collagen deposition in the alloxan-induced diabetic group (DG) and it was significantly reduced in both T1G and T2G. Additionally, a significant change in the expression of several hepatic genes was observed. Fbp1, G6pc, and Pklr showed an upregulation while a downregulation was detected in the expression of Pck1 in DG. A significant restoration was observed in Fbp1, and G6pc after PRP treatment but no change was observed in Pklr expression. Genes of glycolytic pathway, Hk1 and Gck, were downregulated significantly in DG compared to CG and PRP treatment restore the expression in both treated groups T1G and T2G. Moreover, Wnt2, Wnt4, and Wnt9a genes of the Wnt signaling pathway were also upregulated in DG, conversely, downregulate in T1G and T2G. No significant change in expression of Wnt5b and Wnt9b was observed in DG compared to control. Current study revealed that PRP anticipates a reduction in glucose production and glucose consumption by ameliorating hepatic tissue and modulating the glucose metabolism. So, it may use as one of the adjunctive therapies to treat T2DM in future but further more detailed investigations are suggested.

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“…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. 42 43 These results are in line with our study that diabetes is a risk indicator for acute decompensation, and patients with decompensated cirrhosis without diabetes are more likely to have recompensation.…”

Section: Discussionmentioning

confidence: 99%

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

Wang

Zhao

et al. 2021

BMJ Open

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ObjectivesWe aimed to evaluate recompensation factors among patients with decompensated cirrhosis.DesignA multicentre retrospective case–control study was conducted. Data were collected from and compared between groups of patients with recompensated and acute decompensated cirrhosis. Univariable and multivariable logistic regressions were used to select indicators associated with recompensation among patients with decompensated cirrhosis with different complications. A decision tree with 10-fold cross-validation was used to develop the model to identify patients with recompensation. We followed the transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) guideline for development and reporting of the new model.SettingThe study was conducted in six tertiary public hospitals in Chongqing, China.ParticipantsThis study included 3953 patients with decompensated cirrhosis.ResultsIn the total sample of included patients, there were 553 patients with recompensation and 3400 patients with acute decompensation, including 1158 patients with gastrointestinal bleeding, 1715 patients with a bacterial infection, 104 patients with hepatic encephalopathy and 423 patients with ascites. The most relevant indicator of recompensation selected by the decision tree model was albumin, with a threshold of 40 g/L. Total protein, haemoglobin, basophil percentage, alanine aminotransferase, neutrophil-to-lymphocyte ratio and diabetes were also selected to subsequently distinguish patients. The terminal nodes with a probability of recompensation was 0.89. The overall accuracy rate of the model was 0.92 (0.91–0.93), and it exhibited high specificity (86.9%) and sensitivity (92.6%).ConclusionsThe occurrence of recompensated cirrhosis could be identified by albumin, total protein, haemoglobin, basophil percentage, alanine aminotransferase, neutrophil-to-lymphocyte ratio and diabetes. These simple variables may help clinicians develop a treatment plan to encourage patients with decompensated cirrhosis to recompensate.

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Uncontrolled diabetes mellitus increases risk of infection in patients with advanced cirrhosis

Cited by 14 publications

References 46 publications

Association between Liver Cirrhosis and Diabetes Mellitus: A Review on Hepatic Outcomes

Association between Liver Cirrhosis and Diabetes Mellitus: A Review on Hepatic Outcomes

Effect of heterologous platelet-rich plasma (PRP) on liver and modulation of glucose metabolism and Wnt signaling pathways in diabetic mice

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

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