Diabetes Mellitus Increases the Severity of First Episode of Overt Hepatic Encephalopathy in Decompensated Cirrhosis

Abstract

Background and Aim: Diabetes mellitus is associated with a state of increased inflammation as a result of increased bacterial translocation due to reduced intestinal transit time and SIBO. Diabetes mellitus may alter the course of hepatic encephalopathy (HE) in decompensated cirrhosis. With the increase in cases of NASH related cirrhosis it has become important to study the relation of diabetes with respect to HE as it is one of the main complication in decompensated cirrhosis which affects quality of life. The aim of the study was to identify the role of diabetes mellitus in the development of first episode of overt HE in patients with decompensated cirrhosis. Methods: We conducted a retrospective case control study in the study period January 2015 to December 2015. We enrolled consecutive patients with decompensated cirrhosis of any etiology with overt HE (grade 2–4) and divided them into two groups, those with diabetes (Group I) and those without diabetes (Group II). Severe HE was defined as grade 3 HE and above. Results: A total of 96 patients with overt HE were enrolled of which 58 (60.41%) patients were diabetic (Group I). Severe HE was seen in total of 34 (35.4%) patients of which diabetics were 29 (P < 0.001). The mean serum albumin level in Group I was 2.78 ± 0.32 g/dl and in Group II was 2.54 ± 0.40 g/dl (P = 0.002). The mean INR in Group I vs Group II was 1.76 ± 0.44 vs 2.02 ± 0.57 (P = 0.011). Ammonia levels were higher in Group I which was 87.33 ± 21.72 as against 78.87 ± 22.31 in Group II (P = 0.068). On multivariate analysis infections, severity of HE, serum albumin and age were significant. Conclusion: Diabetic patients had more severe grades of HE and it occurred at lesser biochemical decompensation. The authors have none to declare.