Prognostic significance of glycaemic control in patients with HBV and HCV-related cirrhosis and diabetes mellitus.
OBJECTIVE
Diabetes mellitus (DM) is frequently observed in patients with cirrhosis, particularly that due to hepatitis C virus (HCV) infection. However, no studies have focused on the clinical significance of glycaemic control in cirrhotic patients because of their short life expectancy and poor hepatic function. The aim of this study was to evaluate the prognostic impact of glycaemic control in patients with hepatitis B virus (HBV) and HCV-related cirrhosis and DM.


METHODS
A total of 434 patients with HCV-related (HCV group, n = 88) or HBV-related (HBV group, n = 346) cirrhosis were studied retrospectively. We determined the prevalence of DM and treatment methods for hyperglycaemia and status of glycaemic control, and the patients' outcome.


RESULTS
The prevalence of DM was 43.2% (38/88) in the HCV group and 19.7% (68/346) in the HBV group. Patients in the HCV group were older with a female preponderance. DM was detected before the diagnosis of cirrhosis or simultaneously in 92% and 79% in the HCV and HBV groups, respectively. Most patients were treated with insulin or oral hypoglycaemic agents. However, blood glucose levels were maintained within the normal range in 34.2% of the HCV group and in 23.5% of the HBV group. Forty-six patients died during the observation period in both groups. Hepatic failure was the most common cause of death, and sepsis and variceal bleeding were more frequent in the HCV group than in the HBV group. Multivariate analysis showed that Child-Pugh class was the most important factor for survival in both groups. In the HCV group, the status of glycaemic control was a significant independent factor of survival (P = 0.018). In the HBV group, age and the development of spontaneous bacterial peritonitis were significant.


CONCLUSIONS
DM is more frequent in patients with HCV-related cirrhosis than in patients with HBV. Strict control of blood glucose levels could improve survival in HCV patients. A precise assessment of the risks and benefits of glycaemic control is required to reduce the mortality and morbidity of patients with cirrhosis and DM.
Kwon
S Y
SY
Gil MerDepartment of Internal Medicine, Division of Gastroenterology and Hepatology, Gachon Medical School, Gil Medical Centre, 1198 Guwal-dong, Namdong-gu, Inchon 405-760, Korea. sykwonmd@hotmail.com
Kim
S S
SS
Kwon
O S
OS
Kwon
K A
KA
Chung
M G
MG
Park
D K
DK
Kim
Y S
YS
Koo
Y S
YS
Kim
Y K
YK
Choi
D J
DJ
Kim
J H
JH
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D003920:Diabetes Mellitus / Q000517:prevention & control* / Q000821:virology; D005260:Female; D006509:Hepatitis B / Q000150:complications*; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control* / Q000821:virology; D008103:Liver Cirrhosis / Q000821:virology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies
D001786:Blood Glucose