Bhaduri Gourab, Sridharan Kalyani, Jain Tanmay, Kaur Kirandeep, Patnaik Itish, Gupta Rohit, Sharma Anand
Department of Gastroenterology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
Department of Endocrinology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
J Clin Exp Hepatol. 2025 Sep-Oct;15(5):102593. doi: 10.1016/j.jceh.2025.102593. Epub 2025 May 15.
Hepatogenous diabetes (HD) is a less defined entity which refers to abnormal glucose metabolism occurring as a consequence of liver cirrhosis (LC). This prospective cohort study aimed to examine the effect of HD on the clinical outcomes in decompensated LC.
Consecutive patients with decompensated LC, with no prior diabetes mellitus and/or risk factors of metabolic syndrome, and with glycated hemoglobin (HbA1C) <6.5% and fasting blood sugar (FBS) <126 mg/dl were screened using a 2-h oral glucose tolerance test (OGTT) after 75 g glucose. They were classified as normal glucose tolerance (NGT) (FBS <100 mg/dl; OGTT 2 h <140 mg/dl) and HD (rest of the patients). Any hospital admission for ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, acute kidney injury, or infection was classified as liver-related event (LRE) on follow-up. Outcomes studied were 6-month mortality, overall survival (OS), and LRE during follow-up.
Of 187 patients with decompensated LC (age 44.6 ± 10.1 years; males 85%; etiology: alcohol 70%; mean MELD 17 ± 5), HD was diagnosed in 109 (58.29%) patients. NGT and HD groups were similar in age, gender; MELD score (16 ± 5 vs 18 ± 6, = 0.06), and duration of follow-up. The HD group had higher 6-month mortality (19.27% vs 7.69%; = 0.026) and a higher incidence of LRE at last follow-up (43.12% vs 29.49%; = 0.058) when compared to NGT. OS (Kaplan-Meier log rank χ = 4.39; = 0.03) but not LRE-free survival (Kaplan-Meier log rank χ = 2.0; = 0.15), was significantly lower in HD as compared to the NGT.
Dysglycemia diagnosed by OGTT in decompensated cirrhosis with nondiabetic HbA1C and FBS is common. It portends poorer OS and a higher incidence of LRE.
肝源性糖尿病（HD）是一个定义尚不明确的实体，指因肝硬化（LC）导致的异常糖代谢。这项前瞻性队列研究旨在探讨HD对失代偿期LC临床结局的影响。
连续纳入无既往糖尿病和/或代谢综合征危险因素、糖化血红蛋白（HbA1C）<6.5%且空腹血糖（FBS）<126 mg/dl的失代偿期LC患者，在给予75 g葡萄糖后进行2小时口服葡萄糖耐量试验（OGTT）进行筛查。将他们分为糖耐量正常（NGT）组（FBS<100 mg/dl；OGTT 2小时<140 mg/dl）和HD组（其余患者）。随访期间，任何因腹水、肝性脑病、自发性细菌性腹膜炎、急性肾损伤或感染而住院均被分类为肝脏相关事件（LRE）。研究的结局指标为6个月死亡率、总生存期（OS）以及随访期间的LRE。
在187例失代偿期LC患者中（年龄44.6±10.1岁；男性占85%；病因：酒精性70%；平均终末期肝病模型（MELD）评分17±5），109例（58.29%）患者被诊断为HD。NGT组和HD组在年龄、性别、MELD评分（16±5 vs 18±6，P=0.06）以及随访时间方面相似。与NGT组相比，HD组6个月死亡率更高（19.27% vs 7.69%；P=0.026），且在末次随访时LRE发生率更高（43.12% vs 29.49%；P=0.058）。HD组的OS（Kaplan-Meier对数秩检验χ²=4.39；P=0.03）显著低于NGT组，但无LRE生存期（Kaplan-Meier对数秩检验χ²=2.0；P=0.15）与NGT组无显著差异。
在HbA1C和FBS无糖尿病表现的失代偿期肝硬化患者中，通过OGTT诊断的血糖异常很常见。它预示着较差的OS和更高的LRE发生率。
