Abstract
Background
Diabetes mellitus (DM) is common in patients with cirrhosis and is associated with
increased risk of infection.
Aim
To analyze the impact of uncontrolled DM on infection and mortality among inpatients
with advanced cirrhosis.
Methods
This study utilized the Nationwide Inpatient Sample from 1998 to 2014. We defined
advanced cirrhosis using a validated ICD-9-CM algorithm requiring a diagnosis of cirrhosis
and clinically significant portal hypertension or decompensation. The primary outcome
was bacterial infection. Secondary outcomes included inpatient mortality stratified
by elderly age (age≥70). Multivariable logistic regression analyzed outcomes.
Results
906,559 (29.2%) patients had DM and 109,694 (12.1%) were uncontrolled. Patients who
had uncontrolled DM were younger, had less ascites, but more encephalopathy. Bacterial
infection prevalence was more common in uncontrolled DM (34.2% vs. 28.4%, OR 1.33,
95% CI 1.29–1.37, p<0.001). Although uncontrolled DM was not associated with mortality, when stratified
by age, elderly patients with uncontrolled DM had a significantly higher risk of inpatient
mortality (OR 1.62, 95% CI 1.46–1.81).
Conclusions
Uncontrolled DM is associated with increased risk of infection, and when combined
with elderly age is associated with increased risk of inpatient mortality. Glycemic
control is a modifiable target to improve morbidity and mortality in patients with
advanced cirrhosis.
Keywords
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Article info
Publication history
Published online: November 02, 2020
Accepted:
October 18,
2020
Received:
July 10,
2020
Identification
Copyright
© 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
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- Uncontrolled diabetes mellitus and advanced cirrhosisDigestive and Liver DiseaseVol. 53Issue 6
- PreviewRosenblatt and colleagues recently published an attractive research paper on uncontrolled diabetes mellitus (DM) and the risk of infection in patients with advanced cirrhosis [1]. In this study, the authors found that uncontrolled DM was associated with an increased risk of infection, after controlling for potential confounders. In addition, the combination of uncontrolled DM and elderly age could significantly improve the predictive value of mortality in cirrhosis patients. There is no doubt that the findings of this study will help clinicians pay more attention to the glycemic control of cirrhosis patients, so as to better refine the risk classification.
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- Reply to “Uncontrolled diabetes mellitus and advanced cirrhosis”Digestive and Liver DiseaseVol. 53Issue 6
- PreviewWe appreciate the thoughtful letter from Dr. Zong [1]. While the use of large databases brings significant advantages, there are noteworthy limitations. The most prominent advantage is certainly the enormous power and sample size. Equally important, the Nationwide Inpatient Sample [2], the database utilized in our analysis, provides a nationally representative cohort by sampling hospitals and patients across the United States. However, as discussed in our limitations section [3], we relied on diagnosis codes for the definition of controlled and uncontrolled diabetes.
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