Diabetes mellitus in association with hepatic encephalopathy in patients with hepatitis C virus cirrhosis: correlation with ICU outcome

Abstract

Background There is growing evidence to support the concept that hepatitis C virus (HCV) infection is a risk factor for developing type 2 diabetes mellitus (T2DM) and that diabetes control could affect the prognosis of hepatic encephalopathy.Objective To study the relation between type of DM and HCV cirrhosis and to report any relationship between the outcome of hepatic encephalopathy and the glycemic control in the period before precipitation of encephalopathy.Patients and methods A total of 30 selected diabetic, HCV cirrhotic patients with age ranging from 43 and 70 years (mean, 55.87 years), admitted to the ICU for hepatic encephalopathy, were prospectively enrolled in this study. Cirrhosis was evaluated according to Child classification, whereas encephalopathy was evaluated according to West Haven criteria as well as Richmond agitation sedation score. Glycated hemoglobin was used to assess the glycemic control in the period before precipitation of encephalopathy.Results T2DM was more prevalent than type 1 in association with HCV (83.3% T2DM and 16.7% T1DM). Diabetes control plays no role in increasing the severity of cirrhosis (nonsignificant, with P & 0.249). The diabetic HCV cirrhotic patients admitted for hepatic encephalopathy had shorter ICU stay when DM was well-controlled medically in the period before precipitation of encephalopathy (P & 0.001). Moreover, the mortality was decreased markedly in association with diabetes control (P & 0.01).Conclusion HCV viremia had a higher risk of T2DM than T1DM. Diabetes control has no role in increasing the severity of HCV cirrhosis. In HCV cirrhotic diabetic patients, well- controlled DM could improve the ICU outcome (shorter ICU stay and less mortality) when admitted for hepatic encephalopathy.