Diabetes mellitus is linked to higher mortality in alcohol-related acute-on-chronic liver failure.
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Kumar Ashish, Arora Anil, Sharma Praveen, Maiwall Rakhi, Choudhury Ashok, Arora Vinod, Rela Mohamed, Jothimani Dinesh, Mahtab Mamun A, Devarbhavi Harshad, Eapen Chundamannil E, Goel Ashish, Yaghi Cesar, Ning Qin, Chen Tao, Jia Jidong, Zhongping Duan, Hamid Saeed S, Butt Amna S, Jafri Wasim, Shukla Akash, Tan Seok S, Kim Dong J, Saraya Anoop, Hu Jinhua, Sood Ajit, Goyal Omesh, Midha Vandana, Sahu Manoj, Lee Guan H, Treeprasertsuk Sombat, Thanapirom Kessarin, Mandot Ameet, Shah Samir, Maghade Ravikiran, Lesmana Laurentius A, Lesmana Rinaldi C, Ghazinyan Hasmik, Prasad Virukalpatti G Mohan, Dokmeci Abdul K, Sollano Jose D, Abbas Zaigham, Shrestha Ananta, Lau George K, Payawal Diana A, Shiha Gamal E, Duseja Ajay, Taneja Sunil, Verma Nipun, Rao Padaki N, Kulkarni Anand V, Sharma Mithun, Karim Fazal, Dhiman Radha K, Mishra Ajay K, Alam Shahinul, Yokosuka Osamu, Chowdhury Debashis, Saraswat Vivek A, Kedarisetty Chandan K, Saigal Sanjiv, Yattoo Ghulam N, Koshy Abraham, Patwa Ajay K, Elbasiony Mohamed, Rathi Pravin M, Maharshi Sudhir, Dayal Vishwa M, Jha Ashish K, Kalista Kemal F, Gani Rino A, Yuen Man F, Singh Virendra, Singh Ayaskanta, Sargsyan Violeta A, Huang Chien H, Mukewar Saurabh S, Xin Shaojie, Rajaram Ruveena B, Panackel Charles, Dadhich Sunil, Sachdeva Sanjeev, Kumar Ajay, Behera Sanatan, Maji Prabir, Kamani Lubna, Saithanyamurthi Hemamala V, Varghese Joy, Parikh Pathik, Javed P, Saraf Neeraj, Choudhary Narendra S, Roy Akash, Goenka Mahesh, Kalal Chetan, Devadas Krishnadas, Adali Gupse, de Silva Hithanadura J, Sarin Shiv K, APASL ACLF Research Consortium (AARC) for APASL ACLF working Party
Аннотация
METHODS: This observational study involved data from 5612 ACLF patients with documented 90-day outcomes. We identified 2096 patients with ALD-ACLF precipitated by alcoholic hepatitis. Patients with non-ALD etiologies, mixed etiologies, or non-alcoholic precipitants were excluded. Diabetic and non-diabetic patients were compared using 1:2 propensity score matching based on key baseline covariates. Survival outcomes were assessed using Kaplan-Meier analysis and multivariable Cox regression.
RESULTS: After matching, 109 diabetic patients were compared with 218 well-matched non-diabetic controls. Diabetic patients had significantly lower overall survival (32 vs. 57%) and transplant-free survival (31 vs. 50%) compared to non-diabetics (log-rank p < 0.001). On multivariable Cox regression, DM was independently associated with increased 90-day mortality (HR 1.739, 95% CI 1.262-2.395, p < 0.001), along with elevated serum lactate (HR 1.187 per mmol/L, p < 0.001) and creatinine (HR 1.267 per mg/dL, p < 0.001).
CONCLUSION: Diabetes mellitus is a significant independent predictor of mortality in patients with ALD-ACLF. These findings highlight the need for early identification and integrated management of diabetes in ACLF care pathways to improve clinical outcomes.