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Uncontrolled diabetes mellitus increases risk of infection in patients with advanced cirrhosis

Published:November 02, 2020DOI:https://doi.org/10.1016/j.dld.2020.10.022

      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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      Linked Article

      • Uncontrolled diabetes mellitus and advanced cirrhosis
        Digestive and Liver DiseaseVol. 53Issue 6
        • Preview
          Rosenblatt 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
        • Preview
          We 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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