Diabetes mellitus is associated with gastroesophageal variceal bleeding in cirrhotic patients

Abstract

Diabetes mellitus (DM) has been reported to increase the risk of complications of liver cirrhosis of any etiology and subsequent survival. However, the impact of DM on the development of gastroesophageal variceal bleeding (GEVB) remains unclear. We aimed to elucidate whether DM is an independent risk factor for GEVB among cirrhotic patients. A total of 146 consecutive patients with liver cirrhosis (Child-Pugh Class A, n = 75; Class B, n = 40; and Class C, n = 31) were prospectively enrolled. Data on clinical and biochemical characteristics and history of ascites, GEVB, hepatic encephalopathy, and spontaneous bacterial peritonitis were retrospectively reviewed. Of these 146 patients, 37 (25%) had DM. Patients with DM had significantly higher ratio of Child-Pugh Class B/C (p = 0.043), renal insufficiency (p = 0.002), and history of GEVB (p = 0.006) compared with non-DM patients. GEVB was associated with Child-Pugh Class B/C (p = 0.001), ascites (p = 0.002), hepatic encephalopathy (p = 0.023), and low platelet counts (p < 0.001). Based on stepwise multiple logistic regression analysis, Child-Pugh class B/C [odds ratio (OR) = 4.90, p = 0.003] and DM (OR = 2.99, p = 0.022) were identified as independent predictors of GEVB. In the subgroup analysis, DM significantly correlated with GEVB in patients with Child-Pugh Class A (p = 0.042), but not in patients with Child-Pugh Class B/C (p = 0.128). DM is independently associated with GEVB in cirrhotic patients, especially in those with Child-Pugh Class A.

Protective Effect of Probiotics against Esophagogastric Variceal Rebleeding in Patients with Liver Cirrhosis after Endoscopic Therapy

“…However, in patients with liver cirrhosis, especially in its decompensation stage, serious damage to liver function can lead to disorders of glucose metabolism and an increase in blood sugars [ 41 ]. Elevated blood sugar level, in turn, speeds up the progression of cirrhosis and increases the risk of bleeding, as well as death [ 42 , 43 ], which is consistent with observations in our study. A previous study has shown that the modulation of intestinal microbiota by probiotics may be effective toward prevention and management of diabetes [ 44 ], thus reducing the patients’ risk of rebleeding.…”

Type 2 Diabetes: A Risk Factor for Hospital Readmissions and Mortality in Australian Patients With Cirrhosis

“…While some studies have reported a higher incidence of decompensation events in patients with both compensated cirrhosis and T2D, data are inconsistent. (9,10,(34)(35)(36)(37) It is possible that different patient populations, data sources, coding of patient admitted hospital data, and definitions of decompensation events may explain the disparity between studies.…”

Effect of coexisting diabetes mellitus and chronic kidney disease on mortality of cirrhotic patients with esophageal variceal bleeding

“…Nearly half these deaths occur within 6 weeks from the initial episode of bleeding [ 1 ]. Various factors have been proposed as predictors of outcome of variceal bleeding, some of which include age, gender, stage of cirrhosis, etiology, and associated conditions like renal failure and diabetes mellitus (DM) [ 2 – 5 ].…”

“…Insulin resistance, a characteristic feature of DM, has been proven to be a predictor of portal hypertension [ 15 ] and the development of esophageal varices [ 16 ]. In a hospital-based study with 146 patients with cirrhosis, DM significantly correlated with gastroesophageal variceal bleeding [ 2 ].…”