title: Impaired glucose metabolism increases risk of hepatic decompensation and death in patients with compensated hepatitis C virus-related cirrhosis.
abstract: BACKGROUND
  Glucose metabolism abnormalities frequently coexist with liver cirrhosis; however, the impact of these on liver-related outcomes has not been fully investigated.
  
  
  OBJECTIVE
  We examined the influence of glucose abnormalities on overall mortality and liver-related complications in cirrhotic patients.
  
  
  METHODS
  A prospective cohort of 250 subjects with compensated hepatitis C virus-related cirrhosis and without known diabetes underwent an oral glucose tolerance test and were subsequently followed for a median 201 weeks.
  
  
  RESULTS
  At baseline, 67 (27%) had type 2 diabetes. During follow-up, 28 deaths and 55 first events of decompensation occurred. After adjustment for potential confounding covariates, overall mortality/liver transplant (sHR: 2.2, 95% CI: 1.04-4.6, P=0.04) and hepatic decompensation events (sHR: 1.9, 95% CI: 1.05-3.3, P=0.03) were significantly higher in diabetic patients. Subjects with a HOMA-IR >5 showed higher rates of mortality (sHR: 2.2, 95% CI: 1.03-4.8, P=0.04). The rates of hepatic decompensation were higher in patients with HOMA-IR >3 (sHR: 1.7, 95% CI: 1.04-2.9, P=0.03). Overall, 2h-plasma glucose was the most robust predictor of overall mortality (sHR: 2.5, 95% CI: 1.03-6, P=0.04) and decompensation (sHR: 2.7, 95% CI: 1.4-5.5, P<0.01).
  
  
  CONCLUSIONS
  In compensated HCV-related cirrhotic patients, diabetes and marked insulin resistance are independently associated with poorer overall survival and increased risk of hepatic decompensation.
authors.affiliation: Department of Hepatology, National Institute of Gastroenterology, Havana, Cuba.
authors.forename: Luis
authors.initials: L
authors.lastname: Calzadilla-Bertot
authors.affiliation: Department of Hepatology, National Institute of Gastroenterology, Havana, Cuba; Unit for the Clinical Management of Digestive Diseases, Macarena and Virgen del Rocio University Hospital, Ciberehd, Institute of Biomedicine, University of Seville, Seville, Spain. Electronic address: eduardovilar2000@yahoo.com.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Vilar-Gomez
authors.affiliation: Department of Hepatology, National Institute of Gastroenterology, Havana, Cuba.
authors.forename: Ana
authors.initials: A
authors.lastname: Torres-Gonzalez
authors.affiliation: Department of Hepatology, National Institute of Gastroenterology, Havana, Cuba.
authors.forename: Maray
authors.initials: M
authors.lastname: Socias-Lopez
authors.affiliation: Liver Unit, Department of Gastroenterology, Valencia University General Hospital, Valencia, Spain.
authors.forename: Moises
authors.initials: M
authors.lastname: Diago
authors.affiliation: Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Australia.
authors.forename: Leon A
authors.initials: LA
authors.lastname: Adams
authors.affiliation: Unit for the Clinical Management of Digestive Diseases, Macarena and Virgen del Rocio University Hospital, Ciberehd, Institute of Biomedicine, University of Seville, Seville, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Romero-Gomez
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000378:metabolism*; D018450:Disease Progression; D005260:Female; D005951:Glucose Tolerance Test; D019698:Hepatitis C, Chronic / Q000150:complications / Q000378:metabolism*; D006801:Humans; D007333:Insulin Resistance; D008103:Liver Cirrhosis / Q000150:complications / Q000378:metabolism* / Q000401:mortality; D017093:Liver Failure / Q000209:etiology / Q000378:metabolism* / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015996:Survival Rate
chemical_list: D001786:Blood Glucose
keywords: 2-h plasma glucose; Hepatic decompensation; Insulin resistance; Overall survival; Type 2 diabetes