DM (diabetes mellitus) is present in 20–40% of patients with liver cirrhosis, but its prognostic impact is unclear. Therefore, in the present study, we investigated whether the presence of DM in patients with cirrhosis was associated with increased mortality, and/or with increased incidence of SBP (spontaneous bacterial peritonitis). We reviewed medical and laboratory data of 230 patients with cirrhosis from the period 2001–2011, for whom data were complete in n=226. Follow-up for the outcomes mortality and SBP was performed until May 2012, with only 13 patients lost to follow-up. DM was present at baseline in 78 patients (35%). Median follow-up was 6.2 (interquartile range, 3.1–9.3) years, during which 118 patients died [47 out of 78 with DM (60%), and 71 out of 148 without DM (48%)]. The presence of DM at baseline was not associated with increased mortality after adjustment for age {HR (hazard ratio), 1.00 [95% CI (confidence interval), 0.67–1.50]}. Further adjustment for sex, aetiology of cirrhosis, platelet count and the Child–Pugh or MELD (model for end-stage liver disease) score did not change this finding. During follow-up, 37 patients developed incident SBP (19 with DM and 18 without DM). DM at baseline was associated with incident SBP, even after adjustment for age, sex, aetiology, platelet count and the Child–Pugh [HR, 2.39 (95% CI, 1.10–5.18)] or MELD score [HR, 2.50 (95% CI, 1.16–5.40)]. In conclusion, the presence of DM at baseline in patients with cirrhosis was associated with an increased risk of SBP, which may represent an increased susceptibility to infections. On the other hand, DM was not clearly associated with increased mortality in these patients.
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Research Article|
June 07 2013
Diabetes mellitus at the time of diagnosis ofcirrhosis is associated with higher incidence of spontaneous bacterial peritonitis, but not with increased mortality
Nick Wlazlo;
*Department of Internal Medicine, Catharina Hospital, Eindhoven, The Netherlands
†Department of Gastroenterology, Catharina Hospital, Eindhoven, The Netherlands
‡CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
§Department of Internal Medicine/Laboratory for Metabolism and Vascular Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
Correspondence: Dr Nick Wlazlo (email nickwlazlo@gmail.com).
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Marleen M. van Greevenbroek;
Marleen M. van Greevenbroek
‡CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
§Department of Internal Medicine/Laboratory for Metabolism and Vascular Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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Joyce Curvers;
Joyce Curvers
∥Clinical Laboratory, Catharina Hospital, Eindhoven, The Netherlands
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Erik J. Schoon;
Erik J. Schoon
†Department of Gastroenterology, Catharina Hospital, Eindhoven, The Netherlands
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Pieter Friederich;
Pieter Friederich
†Department of Gastroenterology, Catharina Hospital, Eindhoven, The Netherlands
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Jos W. R. Twisk;
Jos W. R. Twisk
¶The Institute for Research in Extra-mural Medicine, VU University Medical Centre, Amsterdam, The Netherlands
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Bert Bravenboer;
Bert Bravenboer
*Department of Internal Medicine, Catharina Hospital, Eindhoven, The Netherlands
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Coen D. A. Stehouwer
Coen D. A. Stehouwer
‡CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
§Department of Internal Medicine/Laboratory for Metabolism and Vascular Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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Publisher: Portland Press Ltd
Received:
November 05 2012
Revision Received:
March 18 2013
Accepted:
April 08 2013
Accepted Manuscript online:
April 08 2013
Online ISSN: 1470-8736
Print ISSN: 0143-5221
© The Authors Journal compilation © 2013 Biochemical Society
2013
Clin Sci (Lond) (2013) 125 (7): 341–348.
Article history
Received:
November 05 2012
Revision Received:
March 18 2013
Accepted:
April 08 2013
Accepted Manuscript online:
April 08 2013
Citation
Nick Wlazlo, Marleen M. van Greevenbroek, Joyce Curvers, Erik J. Schoon, Pieter Friederich, Jos W. R. Twisk, Bert Bravenboer, Coen D. A. Stehouwer; Diabetes mellitus at the time of diagnosis ofcirrhosis is associated with higher incidence of spontaneous bacterial peritonitis, but not with increased mortality. Clin Sci (Lond) 1 October 2013; 125 (7): 341–348. doi: https://doi.org/10.1042/CS20120596
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