title: Diabetes mellitus is associated with hepatic encephalopathy in patients with HCV cirrhosis.
abstract: OBJECTIVE
  An increased ammonia level of gut bacterial origin is an important mediator in the pathogenesis of hepatic encephalopathy (HE), and constipation is a frequent precipitant of hepatic coma. Because diabetes mellitus (DM) may be associated with delayed gastrointestinal transit, we speculated that its presence in patients with HCV-related cirrhosis would predispose to and exacerbate HE.
  
  
  METHODS
  Sixty-five patients (50 men, 15 women) with HCV-related cirrhosis attending a liver transplantation clinic were assessed for severity of liver disease and presence of DM in a cross-sectional study. A modified Child-Pugh score that excluded HE was calculated. Frequency and severity of HE (absent, mild, and severe) in diabetic and nondiabetic patients were assessed. Clinical severity of cirrhosis and results of neuropsychometric testing in diabetic and nondiabetic patients with mild and severe HE were compared.
  
  
  RESULTS
  Fifty-four patients (83%) had HE (33 mild, 21 severe). Twenty patients (31%) had DM. HE was present in 19 (95%) patients with diabetes and 35 (78%) patients without diabetes (p = 0.087). Severity of HE was greater in diabetic (35% mild, 60% severe) than in nondiabetic patients (58% mild, 20% severe) (p = 0.007). In both the mild and severe HE categories, severity of liver disease in diabetic patients was otherwise milder than in the nondiabetic patients.
  
  
  CONCLUSIONS
  Diabetic patients with HCV cirrhosis have more severe HE. Diabetic patients have severe HE at earlier stages of biochemical decompensation and portal hypertension compared with nondiabetic patients.
authors.affiliation: Center for Liver Disease and Transplantation, New York Weill Cornell Medical Center, New York 10021, USA.
authors.forename: Samuel H
authors.initials: SH
authors.lastname: Sigal
authors.forename: Carmen M
authors.initials: CM
authors.lastname: Stanca
authors.forename: Nickolas
authors.initials: N
authors.lastname: Kontorinis
authors.forename: Carol
authors.initials: C
authors.lastname: Bodian
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ryan
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000821:virology; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology*; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000821:virology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric