Prognosis of hypoglycemia episode in cirrhotic patients during hospitalization

Hung, Tsung–Hsing; Tseng, Chih‐Wei; Tsai, Chen-Chi; Lee, Hsing–Feng

doi:10.1186/s12876-021-01895-2

Cited by 12 publications

(10 citation statements)

References 24 publications

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“…Furthermore, our analysis identified CLD as a significant predictor of mortality. The occurrence of hypoglycaemia in the context of CLD is an established determinant of adverse outcomes 28 . However, how CLD can worsen prognosis in patients with IGF‐2‐mediated hypoglycaemia is not studied.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of literature on Insulin‐like growth factor‐2‐mediated hypoglycaemia in non‐islet cell tumours

Ata,

Choudry,

Khan

et al. 2024

Endocrino Diabet & Metabol

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IntroductionInsulin‐like growth factor‐2 (IGF‐2)‐mediated hypoglycemia is a rare yet clinically significant entity with considerable morbidity and mortality. Existing literature is limited and fails to offer a comprehensive understanding of its clinical trajectory, management and prognostication.MethodsSystematic review of English‐language articles reporting primary patient data on IMH was searched using electronic databases (PubMed, Scopus and Embase) from any date up to 21 December 2022. Data were analysed in STATA‐16.ResultsThe systematic review contains 172 studies, including 1 Randomised controlled trial, 1 prospective observational study, 5 retrospective observational studies, 150 case reports, 11 case series and 4 conference abstracts. A total of 233 patients were analysed, averaging 60.6 ± 17.1 years in age, with comparable proportions of males and females. The commonest tumours associated with Insulin‐like Growth Factor‐2‐mediated hypoglycaemia were fibrous tumours (N = 124, 53.2%), followed by non‐fibrous tumours originating from the liver (N = 21, 9%), hemangiopericytomas (N = 20, 8.5%) and mesotheliomas (N = 11, 4.7%). Hypoglycaemia was the presenting feature of NICT in 42% of cases. Predominant clinical features included loss of consciousness (26.7%) and confusion (21%). The mean IGF‐2 and IGF‐1 levels were 882.3 ± 630.6 ng/dL and 41.8 ± 47.8, respectively, with no significant correlation between these levels and patient outcomes. Surgical removal was the most employed treatment modality (47.2%), followed by medication therapy. The recovery rate was 77%, with chronic liver disease (CLD) significantly associated with a poor outcome (OR: 7.23, P: 0.03). Tumours originating from fibrous tissues were significantly associated with recovery (p < .001). In the logistic regression model, CLD remained a significant predictor of poor outcomes.ConclusionThis systematic review highlights that most non‐islet‐cell tumour‐hypoglycaemia (NICTH) is due to fibrous tumours. NICTs demonstrate a variable prognosis, which is fair if originating from fibrous tissue. Management such as octreotide, corticosteroids, diazoxide, embolization, radiotherapy and surgical resection have disparate success rates.

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Section: Discussionmentioning

confidence: 99%

A systematic review of literature on Insulin‐like growth factor‐2‐mediated hypoglycaemia in non‐islet cell tumours

Ata,

Choudry,

Khan

et al. 2024

Endocrino Diabet & Metabol

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“…However, our study found that glucose was a protective factor for in-hospital mortality in patients with cirrhosis combined with sepsis (OR = 0.996, 95% CI 0.994–0.998). This may be related to the fact that patients with cirrhosis have impaired liver function and insufficient hepatic glycogen reserve, which makes them prone to hypoglycemia 28 . Appropriate maintenance of a certain level of blood glucose helps to provide the body with the necessary energy support and reduces the metabolic burden on the liver, thus exerting a protective effect on such patients.…”

Section: Discussionmentioning

confidence: 99%

Development of a nomogram for predicting in-hospital mortality in patients with liver cirrhosis and sepsis

Lin,

Liao,

Lin

et al. 2024

Sci Rep

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In this study, we aimed to investigate the risk factors associated with in-hospital mortality in patients with cirrhosis and sepsis, establish and validate the nomogram. This retrospective study included patients diagnosed with liver cirrhosis and sepsis in the Medical Information Mart for Intensive Care IV (MIMIC-IV). Models were compared by the area under the curve (AUC), integrated discriminant improvement (IDI), net reclassification index (NRI) and decision curve analysis (DCA). A total of 1,696 patients with cirrhosis and sepsis were included in the final cohort. Our final model included the following 9 variables: age, heartrate, total bilirubin (TBIL), glucose, sodium, anion gap (AG), fungal infections, mechanical ventilation, and vasopressin. The nomogram were constructed based on these variables. The AUC values of the nomograms were 0.805 (95% CI 0.776–0.833), which provided significantly higher discrimination compared to that of SOFA score [0.684 (95% CI 0.647–0.720)], MELD-Na [0.672 (95% CI 0.636–0.709)] and ABIC [0.674(95% CI 0.638–0.710)]. We established the first nomogram for predicting in-hospital mortality in patients with liver cirrhosis and sepsis based on these factors. This nomogram can performs well and facilitates clinicians to identify people at high risk of in-hospital mortality.

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“…Univariate and multivariate analysis showed that the short-term prognosis of patients with hypoglycemia was significantly worse than that of patients without hypoglycemia. A study of 636 patients with decompensated cirrhosis without diabetes by Hung et al (18) found that the 30-day mortality of patients with hypoglycemia was as high as 30.2%. In contrast, the 30-day mortality of patients without hypoglycemia was only 7.4%, which was similar to the results of this study.…”

Section: Discussionmentioning

confidence: 99%

Hypoglycemia on admission in patients with acute on chronic liver failure: a retrospective cohort analyzing the current situation, risk factors, and associations with prognosis

Yang¹,

Liu²,

Wang³

et al. 2023

Ann Palliat Med

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Background: Hypoglycemia is a common phenomenon in patients with various severe liver diseases.However, its implications for the prognosis of patients with acute on chronic liver failure remains largely unknown. This study investigated the status of hypoglycemia in patients with acute on chronic liver failure, as well as its risk factors and correlation with 90-day patient outcomes.Methods: A total of 218 patients with acute on chronic liver failure diagnosed and treated in our hospital from January 2019 to August 2021 were enrolled. Hypoglycemia is defined as a fasting blood glucose level ≤2.8 mmol/L. Baseline data on the patients' clinical characteristics and laboratory examinations were collected. Patients were followed-up with a primary outcome of 90-day mortality. The risk factors for hypoglycemia were identified by univariate and multivariate logistic regression.Results: A total of 99 cases (45.41%) had hypoglycemia. Liver cirrhosis [odds ratio (OR) =5.16, P<0.001] and a higher model for end-stage liver disease (MELD) score (OR =1.29, P<0.001) were risk factors for hypoglycemia in acute on chronic liver failure, while higher fibrinogen (FIB) was a protective factor for hypoglycemia (OR =0.17, P=0.001). The 90-day mortality rate in the hypoglycemia group was significantly higher than that in the non-hypoglycemia group (72.73% vs. 48.74%, P<0.001). After adjusting for hepatic encephalopathy, cirrhosis, and MELD scores, hypoglycemia (OR =8.72, P=0.01) was still an independent risk factor for 90-day mortality in patients with acute on chronic liver failure.Conclusions: Hypoglycemia is common in patients with acute on chronic liver failure and is related to poor prognosis. Patients with cirrhosis, a higher MELD score, and a significant decrease in FIB are more likely to develop hypoglycemia. Thus whether ameliorating hypoglycemia could improve patient outcomes deserves additional investigations.

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Prognosis of hypoglycemia episode in cirrhotic patients during hospitalization

Cited by 12 publications

References 24 publications

A systematic review of literature on Insulin‐like growth factor‐2‐mediated hypoglycaemia in non‐islet cell tumours

A systematic review of literature on Insulin‐like growth factor‐2‐mediated hypoglycaemia in non‐islet cell tumours

Development of a nomogram for predicting in-hospital mortality in patients with liver cirrhosis and sepsis

Hypoglycemia on admission in patients with acute on chronic liver failure: a retrospective cohort analyzing the current situation, risk factors, and associations with prognosis

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