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

Abstract

Although there is evidence that type 2 diabetes mellitus (T2D) impacts adversely on liver‐related mortality, its influence on hospital readmissions and development of complications in patients with cirrhosis, particularly in alcohol‐related cirrhosis (the most common etiological factor among Australian hospital admissions for cirrhosis) has not been well studied. This study aimed to investigate the association between T2D and liver cirrhosis in a population‐based cohort of patients admitted for cirrhosis in the state of Queensland, Australia. A retrospective cohort analysis was conducted using data from the Queensland Hospital Admitted Patient Data Collection, which contains information on all hospital episodes of care for patients with liver cirrhosis, and the Death Registry during 2008‐2017. We used demographic, clinical data, and socioeconomic characteristics. A total of 8,631 patients were analyzed. A higher proportion of patients with T2D had cryptogenic cirrhosis (42.4% vs. 27.3%, respectively; P < 0.001) or nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (13.8% vs. 3.4%, respectively; P < 0.001) and an admission for hepatocellular carcinoma (18.0% vs. 12.2%, respectively; P < 0.001) compared to patients without T2D. Patients with liver cirrhosis with T2D compared to those without T2D had a significantly increased median length of hospital stay (6 [range, 1‐11] vs. 5 [range, 1‐11] days, respectively; P < 0.001), double the rate of noncirrhosis‐related admissions (incidence rate ratios [IRR], 2.03; 95% confidence interval [CI], 1.98‐2.07), a 1.35‐fold increased rate of cirrhosis‐related admissions (IRR, 1.35; 95% CI, 1.30‐1.41), and significantly lower survival (P < 0.001). Conclusion: Among hospitalized patients with cirrhosis, the cohort with T2D is at higher risk and may benefit from attention to comorbidities and additional support to reduce readmissions.

The Effect of Serum Glucose Levels on Progression of Fibrosis in Patients with Chronic Hepatitis C Infection

“…Baseline factors associated with longitudinal FIB-4 patterns were shown in Table 3 The results of present study showed that hyperglycaemia was positively associated with advanced brosis. It was consistent with previous reports [20][21][22][23][24]. Previous study also shows that insulin resistance is signi cant associated with liver brosis [22,25].…”

Bacteraemia, sepsis and antibiotic resistance in Australian patients with cirrhosis: a population-based study

“…Alcohol and diabetes were included in both models due to previously reported associations with susceptibility to infection and in-hospital mortality. [23][24][25] Sensitivity analyses were conducted by repeating the analysis excluding 1-day admissions,. Multivariable logistic regression was also used to examine factors that were independent predictors of in-hospital mortality.…”

“…We have, therefore, created a second model with diabetes as an indicator of comorbidity risk, as it is a common comorbid condition in patients with cirrhosis and is associated with adverse patient outcomes including morbidity and mortality. 23 Results are presented as ORs with 95% CIs.…”

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

“…T2DM, in particular, is associated with adverse outcomes in patients with LC, including higher rate of hospital admissions, higher prevalence of HCC, and increased risk of mortality [ 11 ].…”

“…Numerous studies have shown that DM could negatively influence liver-related outcomes [ 10 , 11 , 14 ]. However, a more systematic approach is needed to confirm this association and to determine if diabetic patients with LC may benefit from a closer follow-up.…”