Uncontrolled Glycaemia Is the Strongest Predictive Factor of Liver-Related and Cardiovascular Death in Diabetic Patients with Cirrhosis

Abstract

Diabetes is a common comorbidity in cirrhotic patients; there are insufficient studies in this context. Aim: to investigate risk factors for liver-related death (LRD) and cardiovascular death (CVD) in a cohort of diabetic patients with cirrhosis. Follow-up 10 years. We included 380 diabetics with cirrhosis, according to Child-Pugh: 141(37.1%) A, 170(44.7%) B, 69(18.2%) C. Thirty three (8.7%) died for LRD, 29(7.6%) died for CVD. Those died for LRD, compared with those alive, had higher glucose 211±80 vs. 143±62 mg/dL p<0.0001; HbA1c 8.0±1.4 vs. 6.8±1.1% p<0.0001. Univariate analysis (UA): hepatic encephalopathy (HE) p=0.02; ascites, spontaneous bacterial peritonitis (SBP), HbA1c >7.0%, and decompensated cirrhosis (Child B/C) were factors associated with LRD p<0.0001. Variceal bleeding (VB) was not significant (NS). Multivariate analysis (MA): only HbA1c >7.0% was associated with liver-related death HR=3.0; 95% CI=1.4-6.6 p<0.006. Those died for CVD had higher glucose 230±92 vs. 143±62 mg/dL p<0.0001; HbA1c 8.8±1.6 vs. 6.8±1.1% p<0.0001. UA: ascites p=0.001; HE, SBP, HbA1c ≥7.0% were associated with CVD p<0.0001. Child B/C and VB were NS. MA: HbA1c ≥7.0% was the strongest factor related to CVD HR=8.4; 95% CI=3.1-22.6 p<0.0001. Uncontrolled glycaemia is the most important risk factor predicting LRD and CVD. A tight glycemic control is need in cirrhotic patients. Disclosure F. Higuera-de la Tijera: Speaker's Bureau; Spouse/Partner; Eli Lilly and Company, Novartis Pharmaceuticals Corporation, Takeda Development Center Americas, Inc., Sanofi-Aventis, Silanes. A.I. Servin-Caamano: Speaker's Bureau; Self; Novartis Pharmaceuticals Corporation, Takeda Development Center Americas, Inc., Eli Lilly and Company, Sanofi-Aventis, silanes. A. Navarro-Estrada: None. R. Rábago-Escoto: None. A. Cruz-Estrada: None. E.G. Alexanderson-Rosas: Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Takeda Development Center Americas, Inc., Sanofi, Silanes, Novo Nordisk Inc., Novartis Pharmaceuticals Corporation, Janssen Pharmaceuticals, Inc..