The American journal of medicine · 2026
The effect of SGLT-2 inhibitors on portal hypertensive complications and mortality in patients with cirrhosis.
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Rao Abhinav K, Ibrahim Ahmed, Rockey Don C
Аннотация
INTRODUCTION: We hypothesized that SGLT-2 inhibitors (SGLT-2is) may have beneficial effects on portal hypertension in patients with cirrhosis.
METHODS: Using TriNetX, we identified adults with cirrhosis treated with SGLT-2is. Patients prescribed SGLT-2is within 12 months of a cirrhosis diagnosis were examined (vs. no treatment). Three subgroups were examined: MASH cirrhosis, alcohol-associated cirrhosis, and "other" cirrhosis. To control for liver disease severity/etiology, propensity score matching (PSM) incorporating 47 variables was performed within each subgroup.
RESULTS: PSM resulted in a total of 10,976 cirrhosis patients (compensated and decompensated together; 5488 each SGLT-2i/control), composed of three matched subgroups (MASH (6052); alcohol (2864); other (2060)). After matching, baseline characteristics were similar in patients prescribed SGLT-2is and controls. Patients receiving SGLT-2is developed significantly fewer new portal hypertensive complications, including ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, and hepatorenal syndrome (any portal hypertensive complication risk; MASH: HR 0.73, 95%CI 0.64-0.83; alcohol: HR 0.58, 95%CI 0.49-0.68; other: HR 0.60, 95%CI 0.47-0.76; all P < 0.001). The complication with the greatest reduction was ascites. In sensitivity analyses of decompensated cirrhosis patients, the development of a new portal hypertension complication was lower in those prescribed SGLT-2is. Patients prescribed SGLT-2is had a reduced risk of all-cause mortality (MASH: HR 0.57, 95%CI 0.49-0.66; alcohol: HR 0.65, 95%CI 0.55-0.77; other: HR 0.49, 95%CI 0.39-0.62; all P < 0.001).
CONCLUSION: Cirrhosis patients prescribed SGLT-2is had decreased portal hypertensive complications and increased survival compared to those not receiving SGLT-2is.
METHODS: Using TriNetX, we identified adults with cirrhosis treated with SGLT-2is. Patients prescribed SGLT-2is within 12 months of a cirrhosis diagnosis were examined (vs. no treatment). Three subgroups were examined: MASH cirrhosis, alcohol-associated cirrhosis, and "other" cirrhosis. To control for liver disease severity/etiology, propensity score matching (PSM) incorporating 47 variables was performed within each subgroup.
RESULTS: PSM resulted in a total of 10,976 cirrhosis patients (compensated and decompensated together; 5488 each SGLT-2i/control), composed of three matched subgroups (MASH (6052); alcohol (2864); other (2060)). After matching, baseline characteristics were similar in patients prescribed SGLT-2is and controls. Patients receiving SGLT-2is developed significantly fewer new portal hypertensive complications, including ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, and hepatorenal syndrome (any portal hypertensive complication risk; MASH: HR 0.73, 95%CI 0.64-0.83; alcohol: HR 0.58, 95%CI 0.49-0.68; other: HR 0.60, 95%CI 0.47-0.76; all P < 0.001). The complication with the greatest reduction was ascites. In sensitivity analyses of decompensated cirrhosis patients, the development of a new portal hypertension complication was lower in those prescribed SGLT-2is. Patients prescribed SGLT-2is had a reduced risk of all-cause mortality (MASH: HR 0.57, 95%CI 0.49-0.66; alcohol: HR 0.65, 95%CI 0.55-0.77; other: HR 0.49, 95%CI 0.39-0.62; all P < 0.001).
CONCLUSION: Cirrhosis patients prescribed SGLT-2is had decreased portal hypertensive complications and increased survival compared to those not receiving SGLT-2is.