Impaired glucose metabolism increases risk of hepatic decompensation and death in patients with compensated hepatitis C virus-related cirrhosis

• Published in: Digestive and liver disease 2016-03, Vol.48 (3), p.283-290
• Main Authors: Calzadilla-Bertot, Luis, Vilar-Gomez, Eduardo, Torres-Gonzalez, Ana, Socias-Lopez, Maray, Diago, Moises, Adams, Leon A, Romero-Gomez, Manuel
• Format: Article
• Language: English
• Subjects: 2-h plasma glucose; Aged; Blood Glucose - metabolism; Cohort Studies; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - metabolism; Disease Progression; Female; Gastroenterology and Hepatology; Glucose Tolerance Test; Hepatic decompensation; Hepatitis C, Chronic - complications; Hepatitis C, Chronic - metabolism; Humans; Insulin Resistance; Liver Cirrhosis - complications; Liver Cirrhosis - metabolism; Liver Cirrhosis - mortality; Liver Failure - etiology; Liver Failure - metabolism; Liver Failure - mortality; Liver Failure - surgery; Liver Transplantation; Longitudinal Studies; Male; Middle Aged; Overall survival; Prognosis; Proportional Hazards Models; Prospective Studies; Survival Rate; Type 2 diabetes
• ISSN: 1590-8658; 1878-3562
• DOI: 10.1016/j.dld.2015.12.002

Abstract Background Glucose metabolism abnormalities frequently coexist with liver cirrhosis; however, the impact of these on liver-related outcomes has not been fully investigated. Aims We examined the influence of glucose abnormalities on overall mortality and liver-related complications in cirrhotic patients. Methods A prospective cohort of 250 subjects with compensated hepatitis C virus-related cirrhosis and without known diabetes underwent an oral glucose tolerance test and were subsequently followed for a median 201 weeks. Results At baseline, 67 (27%) had type 2 diabetes. During follow-up, 28 deaths and 55 first events of decompensation occurred. After adjustment for potential confounding covariates, overall mortality/liver transplant (sHR: 2.2, 95% CI: 1.04–4.6, P = 0.04) and hepatic decompensation events (sHR: 1.9, 95% CI: 1.05–3.3, P = 0.03) were significantly higher in diabetic patients. Subjects with a HOMA-IR >5 showed higher rates of mortality (sHR: 2.2, 95% CI: 1.03–4.8, P = 0.04). The rates of hepatic decompensation were higher in patients with HOMA-IR >3 (sHR: 1.7, 95% CI: 1.04–2.9, P = 0.03). Overall, 2h-plasma glucose was the most robust predictor of overall mortality (sHR: 2.5, 95% CI: 1.03–6, P = 0.04) and decompensation (sHR: 2.7, 95% CI: 1.4–5.5, P < 0.01). Conclusions In compensated HCV-related cirrhotic patients, diabetes and marked insulin resistance are independently associated with poorer overall survival and increased risk of hepatic decompensation.