1Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: email@example.com.
2Sanofi Aventis R&D, Paris, France.
3Department of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.
4Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
BACKGROUND & AIMS:
It remains unclear whether diabetes increases the risk for hepatic encephalopathy (HE) in cirrhosis patients. We examined this question using data from three randomized trials of satavaptan, a vasopressin receptor antagonist that does not affect HE risk, in cirrhosis patients with ascites.
The trials included 1198 patients, and we excluded those with HE before or at randomization and followed the remaining patients for the one-year duration of the trials. They were examined for HE regularly, and we compared ratesoffirst-timeovertHE between diabetics and non-diabetics using Cox regression, adjusting for gender, age, ascites severity, cirrhosis etiology, Child-Pugh class, creatinine, bilirubin, INR, sodium, potassium, albumin, platelets, lactulose use, benzodiazepine/barbiturate use, spironolactone dose, furosemide dose, potassium-sparing diuretic dose, and CirCom comorbidity score.
We included 862 patients of whom 193 (22%) had diabetes. In total, they experienced 115first-timeepisodesofovertHE during the follow-up. Fewerdiabeticsthannon-diabeticswereinChild-PughclassCatbaseline(13%vs.23%), yet they had higher cumulative risk of first-timeovertHE (26.0% vs. 15.8% after 1 year), and their episodes of first-timeovertHE were more likely to progress beyond grade 2 (64% vs. 42% of episodes progressed to grade 3 or 4, P=0.01forindependencebetweendiabetesandhighestHEgrade). After the confounder adjustment, the hazard ratio of first-time overt HE for diabetics vs. non-diabetics was 1.86 (95% CI 1.20-2.87).
Diabetes increased the risk of first-time overt HE among cirrhosis patients with ascites.