title: Patients with Diabetes Mellitus are Prone to Develop Severe Hepatitis and Liver Failure due to Hepatitis Virus Infection.
abstract: BACKGROUND
  Acute viral hepatitis (AVH) is usually a self-limiting illness. Diabetics are prone to develop liver diseases and liver regeneration is impaired in them. Natural course of AVH in diabetics has not been assessed and may be severe.
  
  
  METHODS
  Observational prospective study to evaluate natural course of AVH in patients with and without diabetes mellitus. Consecutive patients with AVH were included and categorized in to those with or without diabetes. Etiology, complications, mortality and recovery parameters of AVH were identified and compared between two groups.
  
  
  RESULTS
  131 consecutive AVH between March 2007 and March 2009 were evaluated; 12 diabetics and 83 non-diabetics (n = 95) were included for analysis. Hepatitis E was the commonest cause (n = 55, 57.89%) in the whole cohort. However, Hepatitis B virus (HBV) as the etiology was significantly higher among diabetics than in non-diabetics (58.33% vs. 25.3%, P = 0.02). In contrast, hepatitis E was the etiology in 61.44% of non-diabetics. Frequency of severe hepatitis was significantly higher in diabetics than in non-diabetics (5/12; 41.67% vs. 9/83; 10.64%, P < 0.005). 5 of 14 (36%) with severe hepatitis were diabetics. Liver failure and death occurred in 2 (16%) diabetics, while none among the non-diabetics had liver failure. Multiple variable logistic regression analysis revealed that acute hepatitis B (OR 4.7 (95% CI 1.34-16.47)) and diabetes (OR 4.0 (95% CI 0.96-16.47)) were associated with severe hepatitis.
  
  
  CONCLUSIONS
  Patients with diabetes are at risk to contact HBV infection and severe hepatitis.
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Kumar K
authors.initials: KK
authors.lastname: Singh
authors.affiliation: Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Subrat K
authors.initials: SK
authors.lastname: Panda
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.lastname: Shalimar
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Subrat K
authors.initials: SK
authors.lastname: Acharya
keywords: ALF, acute liver failure; ALT, alanine transaminase; AVH, acute viral hepatitis; BMI, body mass index; HAV, hepatitis A virus; HBV, hepatitis B virus; HEV, hepatitis E virus; LFT, liver function tests; NAFLD, non-alcoholic fatty liver disease; acute viral hepatitis; diabetes; severe hepatitis