Glycemic homeostasis in chronic viral hepatitis and liver cirrhosis

This study aimed at investigating the respective impacts of virus-related chronic hepatitis (CH) and liver cirrhosis (LC) on glycemic homeostasis, with reference to grading and/or staging of liver disease and to contribution of the two main responsible viruses.

The glycometabolic features of 82 patients with CH (B-related 16, and C-related 66) and 145 with LC (B-related 24, and C-related 121) were evaluated.

Impaired glucose tolerance (IGT) was detected in 9 (11.0%) and diabetes mellitus (DM) in 6 (7.3%) of the CH patients [(P<0.05 vs controls, in both cases; respective odds ratios (95% CI): 2.6 (1.1-6.3), and 4.0 (1.2-13.2)]. IGT was detected in 86 (59.3%) and DM in 34 (23.4%) of the LC patients [(P=0.000 vs controls, in both cases; respective odds ratios: 10.0 (7.0-14.4), and 5.5 (3.5-8.5)]. The odds ratios for the prevalence of IGT and DM in the LC patients were 11.8 (5.2-27.5) and 3.9 (1.5-10.8), compared with the CH patients. In the CH patients, glycometabolic failure was significantly related to age (P=0.026), but not to grading and staging, and in the LC patients to Pugh-Child score (P=0.037). IGT was found in 17/40 (42.5%) HBV-related patients and in 13/40 (32.5) matched HCV-related patients. DM was found in 9/40 (22.5%) HBV-related patients and in 10/40 (25.0%) HCV-related matched patients, without significant difference in the respective proportions.

The prevalence of DM associated to virus-related CH is on average four times higher than in the general population, independently of the histopathological picture of disease. Virus-related LC further increases the prevalence of both IGT and DM, independently of sex and age, but in relationship with the severity of disease. HBV and HCV infections do not appear to have a different impact on glycemic homeostasis.