Editor's Note: Over time, alcohol consumption has become a significant public health concern. Alcohol is associated with more than 200 diseases, including diabetes and cirrhosis, contributing to 5.3% of global mortality. Despite increased awareness of alcohol's harmful effects, overall consumption levels have not decreased. Previous studies have investigated the impact of diabetes on patients with alcoholic cirrhosis, but the relationship between diabetes and clinical outcomes in these patients has remained unclear. Recently, a study published in Hepatology International has shed light on the relationship between diabetes and clinical outcomes in patients with alcohol-related cirrhosis.Background
Alcohol consumption is closely linked to cirrhosis and is a major risk factor for poor outcomes in cirrhosis patients. As a result, patients with alcohol-related cirrhosis have worse prognoses compared to those with other causes, with an increased risk of both compensated and decompensated liver function. Globally, alcohol is responsible for 25% of deaths related to cirrhosis.
Chronic heavy drinking is also a contributing factor to diabetes. The high caloric intake from excessive alcohol consumption can trigger pancreatitis, leading to diabetes. Cirrhosis and diabetes can also mutually influence each other. Cirrhosis disrupts glucose homeostasis, exacerbating diabetes through impaired insulin sensitivity and β-cell dysfunction. Consequently, the prevalence of diabetes among cirrhosis patients ranges from 20% to 70%. Several studies have shown that diabetes can worsen cirrhosis-related complications, such as hepatic encephalopathy. However, the impact of diabetes on mortality in cirrhosis patients remains unclear. Given its clinical significance, the researchers conducted this study to explore the relationship between diabetes and the risk factors for alcoholic cirrhosis. They also performed a comparative analysis of cumulative liver transplant risk or mortality among patients with and without diabetes, aiming to fully understand the impact of diabetes on patients with alcoholic cirrhosis.
Methods
Researchers prospectively collected multicenter data from 2015 to 2019, including 965 patients with alcoholic cirrhosis who were hospitalized due to acute decompensation. The study assessed and compared the primary risk factors and incidence of death or liver transplantation among patients with and without diabetes. To ensure accurate comparisons, propensity score (PS) matching was performed at a 1:2 ratio.
Results
The average age of the participants was 53.4 years, with 81.0% being male (n=782), and 23.6% of patients (n=228) had diabetes at baseline. Diabetes was positively correlated with hepatic encephalopathy and upper gastrointestinal bleeding, though the findings were not statistically significant.
During a median follow-up of 903.5 person-years (PYs), 64 patients with diabetes and 171 patients without diabetes died or underwent liver transplantation, with an annual incidence rate of 33.6/100 PYs and 24.0/100 PYs, respectively. In the PS-matched cohort, the incidence of death or liver transplantation was 36.8/100 PYs in the diabetes group and 18.6/100 PYs in the matched control group.
After adjusting for various factors, diabetes significantly increased the short-term and long-term risk of death or liver transplantation in patients with alcoholic cirrhosis, in addition to factors such as prolonged prothrombin time, low serum albumin, elevated total bilirubin and creatinine levels, and decreased serum sodium levels.
Conclusion
The study demonstrates that diabetes increases the risk of death or liver transplantation in patients with alcoholic cirrhosis. Patients with alcoholic cirrhosis who also have diabetes are more prone to developing hepatic encephalopathy and upper gastrointestinal bleeding compared to those without diabetes. The study underscores the importance of screening for diabetes in patients with alcoholic cirrhosis and highlights the need for personalized treatment interventions for these patients.
