title: Diabetes mellitus and decompensated cirrhosis: risk of hepatic encephalopathy in different age groups.
abstract: BACKGROUND
  The aim of the present study was to examine the association of diabetes mellitus (DM) with the prevalence and severity of hepatic encephalopathy (HE) in patients with decompensated cirrhosis (DC) and determine the impact of age and gender on this relationship.
  
  
  METHODS
  West Haven criteria was used to prospectively evaluate 352 consecutive patients with DC for the presence of HE. Detailed clinicobiochemical profiling of patients was performed. Categorical data and ordered categorical variables were evaluated using the Chi-squared test for independence and trend, respectively. Continuous normal and non-parametric data were evaluated using the t-test and Mann-Whitney U-test, respectively.
  
  
  RESULTS
  At the time of admission, HE was present in 50.3% of patients. In all, 118 patients had DM (33.5%). Patients with DM had a significantly higher prevalence (58.5% vs 42.6%; P = 0.03) and severity of HE (P(trend) = 0.01) than patients without DM. However, there were no significant differences between the two groups in terms of Child-Pugh class, MELD scores, the presence of ascites and esophageal varices. Patients with DM had higher platelet counts than those without DM (P(trend) = 0.003). In age and gender subgroup analyses, older patients and men with DM had significantly greater evidence of HE (P = 0.02 and 0.03, respectively). Multivariate analysis showed that DM (P = 0.03) and older age (P = 0.006) were independently related to HE, whereas the association of gender was non-significant.
  
  
  CONCLUSIONS
  Both DM and older age are independently associated with HE in patients with cirrhosis.
authors.affiliation: Mayo Hospital, King Edward Medical University, Lahore, Pakistan; Center for Biomedical Research, Lahore, Pakistan.
authors.forename: Zeeshan
authors.initials: Z
authors.lastname: Butt
authors.forename: Nauman A
authors.initials: NA
authors.lastname: Jadoon
authors.forename: Osman N
authors.initials: ON
authors.lastname: Salaria
authors.forename: Kamran
authors.initials: K
authors.lastname: Mushtaq
authors.forename: Irbaz B
authors.initials: IB
authors.lastname: Riaz
authors.forename: Ahmed
authors.initials: A
authors.lastname: Shahzad
authors.forename: Ali M
authors.initials: AM
authors.lastname: Hashmi
authors.forename: Shahid
authors.initials: S
authors.lastname: Sarwar
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D048909:Diabetes Complications / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006501:Hepatic Encephalopathy / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors
keywords: diabetes complications; hepatic encephalopathy; liver cirrhosis; old age; 糖尿病并发症，肝性脑病，肝硬化，老龄