Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2021; 27(23): 3372-3385
Published online Jun 21, 2021. doi: 10.3748/wjg.v27.i23.3372
Effect of type 2 diabetic mellitus in the prognosis of acute-on-chronic liver failure patients in China
Rui-Min Lai, Tian-Bin Chen, Yu-Hai Hu, Gui Wu, Qi Zheng
Rui-Min Lai, Yu-Hai Hu, Qi Zheng, Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, Fujian Province, China
Tian-Bin Chen, Department of Laboratory Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, Fujian Province, China
Gui Wu, Department of Orthopedics, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, Fujian Province, China
Author contributions: Lai RM and Chen TB contributed equally to this work; Lai RM, Chen TB, and Zheng Q conceived and designed the study; Chen TB analyzed the data; Hu YH and Wu G collected clinical data of the patients; Lai RM and Zheng Q wrote the manuscript; all authors read and approved the final version of the manuscript.
Supported by Fujian Health Research Talents Training Program, No. 2019-1-42; National Natural Science Foundation of China, No. 81702073; and Fujian Provincial Natural Science Foundation General Project, No. 2020J01955.
Institutional review board statement: This study was approved by the Institutional Review Board of Fujian Medical University.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at bei0825@163.com.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qi Zheng, PhD, Professor, Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou 350005, Fujian Province, China. bei0825@163.com
Received: January 28, 2021
Peer-review started: January 28, 2021
First decision: April 5, 2021
Revised: April 14, 2021
Accepted: May 20, 2021
Article in press: May 20, 2021
Published online: June 21, 2021
Abstract
BACKGROUND

Acute-on-chronic liver failure (ACLF) patients have a high short-term mortality rate, and the severity evaluation of ACLF is necessary for prognostication. Therefore, it was meaningful to evaluate the association between type 2 diabetic mellitus (DM) and ACLF and further explore the feasibility of using DM as a prognostic indicator in ACLF patients. The association between type 2 DM and the prognosis of patients with severe liver disease remains unclear.

AIM

To examine the effect of type 2 DM on the prognosis of patients with ACLF.

METHODS

Clinical data from 222 ACLF patients were collected and analyzed. The patients were categorized into two groups depending on whether they had DM or not, and the clinical data of ACLF patients were measured within 48 h after admission. Complications of ACLF were documented during treatment, such as hepatic encephalopathy, hepatorenal syndrome, acute upper gastrointestinal hemorrhage, and spontaneous peritonitis (SBP). Values of laboratory parameters, complication rates, and hospital mortality rates were compared between two groups.

RESULTS

Among 222 ACLF patients, 38 cases were categorized into DM groups, the mean age was 56.32 years and 73.68% were male. The prognosis of ACLF patients was significantly correlated with DM in univariate [hazard ratio (HR) = 2.4, 95% confidence interval (CI) =1.5-3.7, P < 0.001] and multivariable analysis (HR = 3.17, 95%CI =1.82-5.523, P < 0.001). The incident of SBP (34.21% vs 13.59%, P = 0.038) and other infections like lung, urinary, blood, and cholecyst (44.74% vs 28.26%, P = 0.046) were higher in DM patients than non-DM counterparts. In addition, the ACLF patients with DM tended to have a high mortality rate (P < 0.001). Cumulative survival time was also significantly shorter in the ACLF patients with DM than non-DM.

CONCLUSION

A significant association between DM and the prognosis of ACLF patients was found in China. The ACLF patients with DM had higher incidence of hospital mortality and infection than those without DM.

Keywords: Acute-on-chronic liver failure, Diabetic mellitus, Prognosis, Infection, Type 2 diabetic mellitus

Core Tip: This study evaluated the association between type 2 diabetic mellitus (DM) and the prognosis of acute-on-chronic liver failure (ACLF) patients. The 222 ACLF patients were categorized into two groups depending on whether they had DM or not. Values of laboratory parameters, complication rates, and hospital mortality rates were compared between two groups. We observed a significant association between DM and the prognosis of ACLF patients in the study. The ACLF patients with DM had higher incidence of hospital mortality and infection than those without DM.