Prospective Study
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World J Gastroenterol. Jun 14, 2014; 20(22): 7011-7018
Published online Jun 14, 2014. doi: 10.3748/wjg.v20.i22.7011
Subclinical abnormal glucose tolerance is a predictor of death in liver cirrhosis
Diego García-Compeán, Joel Omar Jáquez-Quintana, Fernando Javier Lavalle-González, José Alberto González-González, Linda Elsa Muñoz-Espinosa, Jesús Zacarías Villarreal-Pérez, Héctor J Maldonado-Garza
Diego García-Compeán, Joel Omar Jáquez-Quintana, José Alberto González-González, Héctor J Maldonado-Garza, Gastroenterology Service and Department of Internal Medicine, University Hospital “Dr. José E. Gonzalez” and Medical School, Universidad Autónoma de Nuevo León, Monterrey 64320, México
Fernando Javier Lavalle-González, Jesús Zacarías Villarreal-Pérez, Endocrinology Service and Department of Internal Medicine, University Hospital “Dr. José E. González” and Medical School, Universidad Autónoma de Nuevo León, Monterrey 64320, México
Linda Elsa Muñoz-Espinosa, Liver Unit, University Hospital “Dr. José E. González” and Medical School, Universidad Autónoma de Nuevo León, Monterrey 64320, México
Author contributions: García-Compeán D designed and coordinated the research and wrote the manuscript; Jáquez-Quintana JO and González-González JA evaluated patients at inclusion and follow-up; Lavalle-González FJ and Villarreal-Pérez JZ participated in laboratory testings and revision of the manuscript; Muñoz-Espinosa LE and Maldonado-Garza HJ reviewed the manuscript.
Supported by Gastroenterology and Endocrinology Services of the University Hospital, Universidad Autónoma de Nuevo León, Monterrey, México
Correspondence to: Diego García-Compeán, MD, Gastroenterology Service and Department of Internal Medicine, University Hospital “Dr. José E. Gonzalez” and Medical School, Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, Monterrey 64320, México. digarciacompean@prodigy.net.mx
Telephone: +52-81-83487315  Fax:+52-81-89891381
Received: November 10, 2013
Revised: February 5, 2014
Accepted: March 19, 2014
Published online: June 14, 2014
Abstract

AIM: To determine if subclinical abnormal glucose tolerance (SAGT) has influence on survival of non-diabetic patients with liver cirrhosis.

METHODS: In total, 100 patients with compensated liver cirrhosis and normal fasting plasma glucose were included. Fasting plasma insulin (FPI) levels were measured, and oral glucose tolerance test (OGTT) was performed. According to OGTT results two groups of patients were formed: those with normal glucose tolerance (NGT) and those with SAGT. Patients were followed every three months. The mean follow-up was 932 d (range of 180-1925). Survival was analyzed by the Kaplan-Meyer method, and predictive factors of death were analyzed using the Cox proportional hazard regression model.

RESULTS: Of the included patients, 30 showed NGT and 70 SAGT. Groups were significantly different only in age, INR, FPI and HOMA2-IR. Patients with SAGT showed lower 5-year cumulated survival than NGT patients (31.7% vs 71.6%, P = 0.02). Differences in survival were significant only after 3 years of follow-up. SAGT, Child-Pugh B, and high Child-Pugh and Model for End-Stage Liver Disease (MELD) scores were independent predictors of death. The causes of death in 90.3% of cases were due to complications related to liver disease.

CONCLUSION: SAGT was associated with lower survival. SAGT, Child-Pugh B, and high Child-Pugh and MELD scores were independent negative predictors of survival.

Keywords: Diabetes mellitus, Liver cirrhosis, Oral glucose tolerance test, Survival, Glucose metabolism disorders

Core tip: In this controlled prospective long term study we demonstrated that subclinical forms of abnormal glucose tolerance (IGT) or diabetes mellitus (DM) may influence survival of non-diabetic cirrhotic patients. Previously it had been demonstrated that clinically overt DM is associated with low survival of cirrhotic patients. This issue is important since a high proportion of cirrhotic patients (about 70%) without history of DM and with normal fasting plasma glucose have subclinical abnormal glucose tolerance. The use of oral glucose tolerance test for early recognition and treatment of DM may improve prognosis of these patients.