Diabetes does not increase infection risk or mortality following an infection in patients with cirrhosis and ascites

Bossen, Lars; Dam, Gitte; Vilstrup, Hendrik; Watson, Hugh; Jepsen, Peter

doi:10.1016/j.jhepr.2019.07.008

Cited by 3 publications

(4 citation statements)

References 29 publications

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“…A prospective case control study on a database of 3 randomized controlled multicentric trials investigating the efficacy of satavaptan in treating ascites compared the risk of infections and mortality following an infection between patients with LC, with or without DM. The study had conflicting results: DM did not increase the HR of infections or the mortality following an infection in any of the diabetic patients receiving different associated treatments: diuretics, quinolones, proton pump inhibitors, lactulose, and non-selective beta-blockers [ 31 ].…”

Section: Resultsmentioning

confidence: 99%

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Association between Liver Cirrhosis and Diabetes Mellitus: A Review on Hepatic Outcomes

Coman

Bădărău

et al. 2021

JCM

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Background: Liver cirrhosis (LC) is largely associated with diabetes mellitus (DM). More than 80% of patients with LC manifest glucose intolerance and about 30% have type 2 DM. A particular and yet unrecognized entity is hepatogenous diabetes (HD), defined as impaired glucose regulation caused by altered liver function following LC. Numerous studies have shown that DM could negatively influence liver-related outcomes. Aim: We aimed to investigate whether patients with LC and DM are at higher risk for hepatic encephalopathy (HE), variceal hemorrhage (VH), infections and hepatocellular carcinoma (HCC). The impact of DM on liver transplant (LT) outcomes was also addressed. Methods: Literature search was performed in PubMed, Ovid, and Elsevier databases. Population-based observational studies reporting liver outcomes in patients with LC were included. Results: Diabetics are at higher risk for HE, including post-transjugular intrahepatic portosystemic shunt HE. DM also increases the risk of VH and contributes to elevated portal pressure and variceal re-bleeding, while uncontrolled DM is associated with increased risk of bacterial infections. DM also increases the risk of HCC and contributes to adverse LT outcomes. Conclusions: Patients with DM and LC may benefit from close follow-up in order to reduce readmissions and mortality. Due to the heterogeneity of available research, prospective multicenter clinical trials are needed to further validate these findings.

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Section: Resultsmentioning

confidence: 99%

“…et al, 2019 showed that T2DM patients had a higher cumulative incidence of PLA than controls (0.87% vs. 0.30%), DM being associated with increased hazard of PLA (HR = 2.88) [ 30 ]. In contrast, Bossen L. et al 2019, found no association between DM and risk of infection in patients with LC and ascites treated with satavaptan [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Association between Liver Cirrhosis and Diabetes Mellitus: A Review on Hepatic Outcomes

Coman

Bădărău

et al. 2021

JCM

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“…Bossen et al took the advantage of 3 cohorts of patients (n = 1,198) with cirrhosis and ascites, included in 3 randomized controlled trials assessing satavaptan in the treatment of ascites, to explore this question. 12 They observed that patients with diabetes did not have an increased rate of infection or death after an infection compared to those without. This seems to be true for different severity stages of diabetes.…”

Section: Cirrhosismentioning

confidence: 98%

JHEP Reports: The fourth issue

Gustot

2019

JHEP Reports

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“…28 In contrast, in decompensated cirrhosis, diabetes does not increase the risk of infection. 29 Patients with decompensated cirrhosis are particularly vulnerable to developing sarcopenia due to impaired oral intake and increased gluconeogenesis from skeletal muscle protein. Frailty and sarcopenia are currently considered to be independent predictors of mortality in decompensated cirrhosis, but it remains unknown whether they are predisposing factors in the transition to decompensated cirrhosis.…”

Section: Predisposing Factorsmentioning

confidence: 99%

Transition to decompensation and acute-on-chronic liver failure: Role of predisposing factors and precipitating events

Gustot

Stadlbauer

Laleman

et al. 2021

Journal of Hepatology

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The transition from compensated to decompensated cirrhosis results from a complex interplay of predisposing and precipitating factors and represents an inflection point in the probability of a patient surviving. With the progression of cirrhosis, patients accumulate multiple disorders (e.g. altered liver architecture, portal hypertension, local and systemic inflammation, bacterial translocation, gut dysbiosis, kidney vasoconstriction) that predispose them to decompensation. On the background of these factors, precipitating events (e.g. bacterial infection, alcoholic hepatitis, variceal haemorrhage, drug-induced liver injury, flare of liver disease) lead to acute decompensation (ascites, hepatic encephalopathy, variceal bleeding, jaundice) and/or organ failures, which characterise acute-on-chronic liver failure. In this review paper, we will discuss the current hypotheses and latest evidences regarding predisposing and precipitating factors associated with the transition to decompensated liver disease.

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Diabetes does not increase infection risk or mortality following an infection in patients with cirrhosis and ascites

Cited by 3 publications

References 29 publications

Association between Liver Cirrhosis and Diabetes Mellitus: A Review on Hepatic Outcomes

Association between Liver Cirrhosis and Diabetes Mellitus: A Review on Hepatic Outcomes

JHEP Reports: The fourth issue

Transition to decompensation and acute-on-chronic liver failure: Role of predisposing factors and precipitating events

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