Mortality and Liver-related Outcomes in Patients with Decompensated Liver Disease and Hepatogenous Diabetes

Hepatogenous diabetes (HD) is a less defined entity which refers to abnormal glucose metabolism occurring as a consequence of liver cirrhosis (LC). This prospective cohort study aimed to examine the effect of HD on the clinical outcomes in decompensated LC.

Consecutive patients with decompensated LC, with no prior diabetes mellitus and/or risk factors of metabolic syndrome, and with glycated hemoglobin (HbA1C) <6.5% and fasting blood sugar (FBS) <126 mg/dl were screened using a 2-h oral glucose tolerance test (OGTT) after 75 g glucose. They were classified as normal glucose tolerance (NGT) (FBS <100 mg/dl; OGTT 2 h <140 mg/dl) and HD (rest of the patients). Any hospital admission for ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, acute kidney injury, or infection was classified as liver-related event (LRE) on follow-up. Outcomes studied were 6-month mortality, overall survival (OS), and LRE during follow-up.

Of 187 patients with decompensated LC (age 44.6 ± 10.1 years; males 85%; etiology: alcohol 70%; mean MELD 17 ± 5), HD was diagnosed in 109 (58.29%) patients. NGT and HD groups were similar in age, gender; MELD score (16 ± 5 vs 18 ± 6, P = 0.06), and duration of follow-up. The HD group had higher 6-month mortality (19.27% vs 7.69%; P = 0.026) and a higher incidence of LRE at last follow-up (43.12% vs 29.49%; P = 0.058) when compared to NGT. OS (Kaplan-Meier log rank χ² = 4.39; P = 0.03) but not LRE-free survival (Kaplan-Meier log rank χ² = 2.0; P = 0.15), was significantly lower in HD as compared to the NGT.

Dysglycemia diagnosed by OGTT in decompensated cirrhosis with nondiabetic HbA1C and FBS is common. It portends poorer OS and a higher incidence of LRE.