Mortality and Liver-related Outcomes in Patients with Decompensated Liver Disease and Hepatogenous Diabetes.

Background: 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. Methods: 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. Results: 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, Conclusion: Dysglycemia diagnosed by OGTT in decompensated cirrhosis with nondiabetic HbA1C and FBS is common. It portends poorer OS and a higher incidence of LRE.