Diabetes mellitus is an independent prognostic factor for... : Hepatology (original) (raw)

Viral Hepatitis

Elkrief, Laure1; Chouinard, Pascale1,4; Bendersky, Noelle2; Hajage, David3; Larroque, Béatrice3; Babany, Gérard1; Kutala, Blaise1; Francoz, Claire1; Boyer, Nathalie1; Moreau, Richard1; Durand, François1; Marcellin, Patrick1; Rautou, Pierre-Emmanuel1; Valla, Dominique1

1_Service d'Hépatologie, Université Paris Diderot and INSERM U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, AP-HP, Clichy, France_

2_Département d'information médicale, Hôpital Beaujon, AP-HP, Clichy, France_

3_Département d'épidémiologie et de recherche clinique Bichat-Beaujon, AP-HP, Clichy, France._

4_Service d'Hépato-Gastroentérologie, CHUQ–Hôpital Saint-François d'Assise, Québec, QUE, Canada_

Received 16 December 2013; Revised 16 April 2014; Accepted 12 May 2014

Address reprint requests to: Dominique Valla, M.D., Service d'Hépatologie, Hôpital Beaujon, AP-HP, 92110 Clichy, France; E-mail: [email protected].fr; fax: +33 1 40 87 44 26.

Potential conflict of interest: Nothing to report.

This work was supported by grants from Roche. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Abstract

In patients with chronic hepatitis C (CHC), cirrhosis is associated with age, gender, diabetes, alcohol abuse, and coinfection with human immunodeficiency virus (HIV) or hepatitis B virus (HBV). The effect of these factors on the outcome of cirrhosis is unknown. This study in CHC patients with cirrhosis aimed to assess the influence of these factors on decompensation, liver transplantation, and death. Consecutive patients with CHC and cirrhosis hospitalized between January 1, 2006 and December 31, 2008 were followed up until death, transplantation, or study closure in March 2013. Gender, age, Model for End-Stage Liver Disease (MELD) score, diabetes, alcohol abuse, HIV, or HBV coinfection were collected at inclusion. The complications of cirrhosis, death, and liver transplantation were recorded at inclusion and during follow-up. The association between baseline factors and liver-related outcomes at inclusion and during follow-up were tested using logistic regression and Cox's model, respectively. A total of 348 patients with CHC and cirrhosis (68% men; median age: 59 years; median MELD: 10) were included. At baseline, 40% of the patients had diabetes, 29% alcohol abuse, and 6% HIV or HBV coinfection. Baseline MELD ≥10 (P < 0.001), diabetes (P = 0.027), and HBV coinfection (P = 0.001) were independently associated with transplantation-free survival. Baseline diabetes was independently associated with ascites (P = 0.05), bacterial infections (P = 0.001), and encephalopathy (P < 0.001) at inclusion. Baseline diabetes was independently associated with development of ascites (P = 0.057), renal dysfunction (P = 0.004), bacterial infections (P = 0.007), and hepatocellular carcinoma (P = 0.016) during the follow-up. Conclusion: In patients with CHC and cirrhosis, diabetes is an independent prognostic factor. Improving diabetes control may improve the outcome of cirrhosis. (Hepatology 2014;60:823–831)

Copyright © 2014 American Association for the Study of Liver Diseases.