Article

Diabetes mellitus is associated with hepatic encephalopathy in patients with HCV cirrhosis

Center for Liver Disease and Transplantation, New York Weill Cornell Medical Center, New York 10021, USA.
The American Journal of Gastroenterology (Impact Factor: 9.21). 08/2006; 101(7):1490-6. DOI: 10.1111/j.1572-0241.2006.00649.x
Source: PubMed

ABSTRACT An increased ammonia level of gut bacterial origin is an important mediator in the pathogenesis of hepatic encephalopathy (HE), and constipation is a frequent precipitant of hepatic coma. Because diabetes mellitus (DM) may be associated with delayed gastrointestinal transit, we speculated that its presence in patients with HCV-related cirrhosis would predispose to and exacerbate HE.
Sixty-five patients (50 men, 15 women) with HCV-related cirrhosis attending a liver transplantation clinic were assessed for severity of liver disease and presence of DM in a cross-sectional study. A modified Child-Pugh score that excluded HE was calculated. Frequency and severity of HE (absent, mild, and severe) in diabetic and nondiabetic patients were assessed. Clinical severity of cirrhosis and results of neuropsychometric testing in diabetic and nondiabetic patients with mild and severe HE were compared.
Fifty-four patients (83%) had HE (33 mild, 21 severe). Twenty patients (31%) had DM. HE was present in 19 (95%) patients with diabetes and 35 (78%) patients without diabetes (p = 0.087). Severity of HE was greater in diabetic (35% mild, 60% severe) than in nondiabetic patients (58% mild, 20% severe) (p = 0.007). In both the mild and severe HE categories, severity of liver disease in diabetic patients was otherwise milder than in the nondiabetic patients.
Diabetic patients with HCV cirrhosis have more severe HE. Diabetic patients have severe HE at earlier stages of biochemical decompensation and portal hypertension compared with nondiabetic patients.

0 Followers
 · 
75 Views
  • [Show abstract] [Hide abstract]
    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 impact 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 1st 2006 and December 31st 2008 were followed-up until death, transplantation or study closure in March 2013. Gender, age, 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 model, respectively. 348 patients with CHC and cirrhosis (68% men, median age 59 years, median MELD 10) were included. At baseline, 29% of the patients had diabetes, 6% alcohol abuse and 6% HIV or HBV coinfection. Baseline MELD ≥10 (p < 0.001), diabetes (p = 0.03) 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 the 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)
    Hepatology 09/2014; 60(3). DOI:10.1002/hep.27228 · 11.19 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Ascites, the most frequent complication of cirrhosis, is associated with poor prognosis and reduced quality of life. Recurrent hospital admissions are common and often unplanned, resulting in increased use of hospital services.AimsTo examine use of hospital services by patients with cirrhosis and ascites requiring paracentesis and to investigate factors associated with early unplanned readmission.MethodsA retrospective review of the medical chart and clinical databases was performed for patients who underwent paracentesis between October 2011 and October 2012. Clinical parameters at index admission were compared between patients with and without early unplanned hospital readmissions.ResultsThe 41 patients requiring paracentesis had 127 hospital admissions, 1164 occupied bed days and 733 medical imaging services. Most admissions (80.3%) were for management of ascites, of which 41.2% were unplanned. Of those eligible, 69.7% were readmitted and 42.4% had an early unplanned readmission. Twelve patients died and 9 developed SBP. Of those eligible for readmission, more patients died (p=0.008) and/or developed SBP (p=0.027) if they had an early unplanned readmission during the study period. Markers of liver disease, as well as haemoglobin (p=0.029), haematocrit (p=0.024) and previous heavy alcohol use (p=0.021) at index admission, were associated with early unplanned readmission.Conclusion Patients with cirrhosis and ascites comprise a small population who account for substantial use of hospital services. Markers of disease severity may identify patients at increased risk of early readmission. Alternative models of care should be considered to reduce unplanned hospital admissions, health care costs and pressure on emergency services.
    Internal Medicine Journal 06/2014; 44(9). DOI:10.1111/imj.12491 · 1.70 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The AASLD/EASL Practice Guideline Subcommittee on Hepatic Encephalopathy are: Jayant A. Talwalkar (Chair, AASLD), Hari S. Conjeevaram, Michael Porayko, Raphael B. Merriman, Peter L. M. Jansen, and Fabien Zoulim. This guideline has been approved by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver and represents the position of both associations.
    Hepatology 08/2014; 60(2). DOI:10.1002/hep.27210 · 11.19 Impact Factor