Diabetes mellitus as an independent prognostic predictor and its association with renal dysfunction in patients with hepatocellular carcinoma

Abstract

Patients with hepatocellular carcinoma (HCC) often have coexisting cirrhosis, which may predispose to the development of diabetes mellitus (DM). Diabetic HCC patients may have renal insufficiency and a subsequent worse outcome. This study investigated the interaction between DM, cirrhosis and renal dysfunction and the impact of these factors on HCC. A prospective database of 1713 HCC patients was analysed. A total of 392 (22.9%) patients were diabetic. Diabetic patients had a significantly higher Child-Turcotte-Pugh (CTP) score, model for end-stage liver disease score and serum creatinine level, but had significantly lower serum albumin, sodium, alanine aminotransferase, aspartate aminotransferase and bilirubin levels. The serum creatinine level progressively increased and correlated well with increasing CTP class in both diabetic and non-diabetic patients. After a mean follow-up of 18+/-16 months, DM was shown to be an independent predictor of mortality in the Cox proportional hazard model after adjusting for other predictors [hazard ratio (HR): 1.2, 95% confidence interval (CI): 1.02-1.42]. Diabetic patients more often had renal insufficiency, defined as serum creatinine>1.5 mg/dl (17.3 vs 8.3%, P<0.0001). Renal insufficiency was an independent prognostic predictor in diabetic patients (HR: 2.26, 95% CI: 1.57-3.24) but not in non-diabetic patients, because it was significantly associated with the severity of cirrhosis in the non-diabetic group (P<0.001) but not in the diabetic group (P=0.143). DM is associated with inadequate liver reserve and independently predicts decreased survival in HCC patients. Both advanced cirrhosis and DM are associated with renal insufficiency, which is a poor prognostic predictor for HCC.