Increased risk of hepatocellular carcinoma among patients with hepatitis C cirrhosis and diabetes mellitus.
Recent studies suggest that diabetes mellitus increases the risk of developing hepatocellular carcinoma (HCC). The aim of this study is to quantify the risk of HCC among patients with both diabetes mellitus and hepatitis C in a large cohort of patients with chronic hepatitis C and advanced fibrosis. We included 541 patients of whom 85 (16%) had diabetes mellitus. The median age at inclusion was 50 years. The prevalence of diabetes mellitus was 10.5% for patients with Ishak fibrosis score 4, 12.5% for Ishak score 5, and 19.1% for Ishak score 6. Multiple logistic regression analysis showed an increased risk of diabetes mellitus for patients with an elevated body mass index (BMI) (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.00-1.11; P = 0.060) and a decreased risk of diabetes mellitus for patients with higher serum albumin levels (OR, 0.81; 95% CI, 0.63-1.04; P = 0.095). During a median follow-up of 4.0 years (interquartile range, 2.0-6.7), 11 patients (13%) with diabetes mellitus versus 27 patients (5.9%) without diabetes mellitus developed HCC, the 5-year occurrence of HCC being 11.4% (95% CI, 3.0-19.8) and 5.0% (95% CI, 2.2-7.8), respectively (P = 0.013). Multivariate Cox regression analysis of patients with Ishak 6 cirrhosis showed that diabetes mellitus was independently associated with the development of HCC (hazard ratio, 3.28; 95% CI, 1.35-7.97; P = 0.009).


CONCLUSIONS
For patients with chronic hepatitis C and advanced cirrhosis, diabetes mellitus increases the risk of developing HCC.
Erasmus MC University Medical Center, Department of Gastroenterology and Hepatology, Rotterdam, the Netherlands.
Bart J
BJ
Veldt
Wendong
W
Chen
E Jenny
EJ
Heathcote
Heiner
H
Wedemeyer
Juerg
J
Reichen
W Peter
WP
Hofmann
Robert J
RJ
de Knegt
Stefan
S
Zeuzem
Michael P
MP
Manns
Bettina E
BE
Hansen
Solko W
SW
Schalm
Harry L A
HL
Janssen
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D015992:Body Mass Index; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000453:epidemiology; D015331:Cohort Studies; D048909:Diabetes Complications / Q000150:complications*; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000150:complications* / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D012720:Severity of Illness Index
D000998:Antiviral Agents; D012709:Serum Albumin