Endocrine Abstracts

Objective: To analyze the effect of DM on frequency and severity of HE in patients with liver cirrhosis.

Methods: Three hundred and fifty-two patients with liver cirrhosis were prospectively assessed for severity of liver disease and presence of DM in a multicenter study. The presence and severity of HE was determined using West Haven criteria. Kolmogorov-Smirnov Goodness-of-Fit Test was used to check normality of continuous variables. Modified Child Pugh score and Model for End Stage Liver Disease scores (MELD) were calculated. Chi-square test for independence was used for categorical data while chi-squares test for trend was employed for ordered categorical variables. T-test and Mann–Whitney U test were used for continuous normal and continuous non-parametric data respectively.

Results: Hepatic encephalopathy (HE) was present in 50.3% of patients at time of admission and 33.5% of patients were diabetic. Chronic hepatitis C was the most common causes of cirrhosis (71.6%). Hepatic encephalopathy at admission was present in 58.5% of diabetics and 42.6% of non-diabetics (P value 0.03). Severity of hepatic encephalopathy was higher in patients with diabetes than those without diabetes (P value for trend 0.01). Chronic Hepatitis C, ascites, esophageal varices, modified Child-pugh class and MELD score were not different in diabetics as compared to non-diabetics. Trend for increasing serum creatinine was significant for diabetics while trend for increasing AST levels and serum bilirubin was significant for non-diabetics (P values 0.04, 0.03, 0.04 respectively). When stratified by age, more patients with diabetes presented with HE as compared to patients without diabetes (74.4 vs 53.2%, P value 0.02) albeit in the older age group only. Among gender subgroup analysis, only males with diabetes had increased HE prevalence (P value 0.03). In the multivariate model with age, gender, and diabetes as predictors and HE as dependent variable, both diabetes and older age were independently associated with HE (P values 0.03 and 0.006 respectively) while gender remained insignificant.

Conclusion: Cirrhotic patients with type 2 diabetes are more likely to present with hepatic encephalopathy than cirrhotic patients without type 2 diabetes. Moreover diabetes and age interact to cause increased prevalence of hepatic encephalopathy in decompensated cirrhosis.