title: Hypoglycemia is associated with increased mortality in patients with acute decompensated liver cirrhosis.
abstract: BACKGROUND
  The liver plays an important role in glucose metabolism, in terms of glucolysis and gluconeogenesis. Several studies have shown that hyperglycemia in patients with liver cirrhosis is associated with progression of the liver disease and increased mortality. However, no study has ever targeted the influence of hypoglycemia. The aim of this study was to assess the association of glucose disturbances with outcome in patients presenting to the emergency department with acute decompensated liver cirrhosis.
  
  
  METHODS
  Our retrospective data analysis comprised adult (≥ 16 years) patients admitted to our emergency department between January 1, 2002, and December 31, 2012, with the primary diagnosis of decompensated liver cirrhosis.
  
  
  RESULTS
  A total of 312 patients were eligible for study inclusion. Two hundred thirty-one (74.0%) patients were male; 81 (26.0%) were female. The median age was 57 years (range, 51-65 years). Overall, 89 (28.5%) of our patients had acute glucose disturbances; 49 (15.7%) of our patients were hypoglycemic and 40 (12.8%) were hyperglycemic. Patients with hypoglycemia were significantly more often admitted to the intensive care unit than hyperglycemic patients (20.4% vs 10.8%, P < .015) or than normoglycemic patients (20.4% vs 10.3%, P < .011), and they significantly more often died in the hospital (28.6% hypoglycemic vs 7.5% hyperglycemic, P < .024; 28.6% hypoglycemic vs 10.3% normoglycemic P < .049). Survival analysis showed a significantly lower estimated survival for hypoglycemic patients (36 days) than for normoglycemic patients (54 days) or hyperglycemic patients (45 days; hypoglycemic vs hyperglycemic, P < .019; hypoglycemic vs normoglycemic, P < .007; hyperglycemic vs normoglycemic, P < .477).
  
  
  CONCLUSIONS
  Hypoglycemia is associated with increased mortality in patients with acute decompensated liver cirrhosis. It is not yet clear whether hypoglycemia is jointly responsible for the increased short-term mortality of patients with acute decompensated liver cirrhosis or is only a consequence of the severity of the disease or the complications.
authors: Department of General Internal Medicine, University Hospital and University of Bern, Bern, Switzerland; Department of Emergency Medicine, University Hospital and University of Bern, Bern, Switzerland. Electronic address: cpfortmueller@gmail.com.
authors: Carmen Andrea
authors: CA
authors: Pfortmueller
authors: Department of Emergency Medicine, University Hospital and University of Bern, Bern, Switzerland. Electronic address: ch.wiemann@googlemail.com.
authors: Christoph
authors: C
authors: Wiemann
authors: Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital Vienna and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria. Electronic address: georg-christian.funk@meduniwien.ac.at.
authors: Georg-Christian
authors: GC
authors: Funk
authors: Center of Laboratory Medicine, University Institute of Clinical Chemistry, Inselspital-Bern University Hospital, Inselspital, Bern, Switzerland. Electronic address: benedikt.leichtle@insel.ch.
authors: Alexander Benedikt
authors: AB
authors: Leichtle
authors: Center of Laboratory Medicine, University Institute of Clinical Chemistry, Inselspital-Bern University Hospital, Inselspital, Bern, Switzerland. Electronic address: georg.fiedler@insel.ch.
authors: Georg Martin
authors: GM
authors: Fiedler
authors: Department of Emergency Medicine, University Hospital and University of Bern, Bern, Switzerland. Electronic address: exadaktylos@exadaktylos.ch.
authors: Aristomenis Konstantinos
authors: AK
authors: Exadaktylos
authors: Department of General Internal Medicine, University Hospital and University of Bern, Bern, Switzerland; Department of Emergency Medicine, University Hospital and University of Bern, Bern, Switzerland. Electronic address: lindner.gregor@gmail.com.
authors: Gregor
authors: G
authors: Lindner
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006943:Hyperglycemia / Q000401:mortality; D007003:Hypoglycemia / Q000401:mortality*; D007362:Intensive Care Units; D008103:Liver Cirrhosis / Q000401:mortality*; D017114:Liver Failure, Acute / Q000150:complications; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: Decompensated liver cirrhosis; Glucose disturbance; Hypoglycemia; Mortality