Diabetes mellitus is linked to higher mortality in alcohol-related acute-on-chronic liver failure.
Acute-on-chronic liver failure (ACLF) is a rapidly progressive syndrome marked by high short-term mortality. While diabetes mellitus (DM) is known to worsen liver-related outcomes, its specific impact on alcohol-related ACLF (ALD-ACLF) remains underexplored. This study aimed to assess the prognostic impact of DM on 90-day outcomes in ALD-ACLF using data from the APASL ACLF Research Consortium (AARC) database.
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.
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).
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.
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.
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).
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.
Authors
Kumar Kumar, Arora Arora, Sharma Sharma, Maiwall Maiwall, Choudhury Choudhury, Arora Arora, Rela Rela, Jothimani Jothimani, Mahtab Mahtab, Devarbhavi Devarbhavi, Eapen Eapen, Goel Goel, Yaghi Yaghi, Ning Ning, Chen Chen, Jia Jia, Zhongping Zhongping, Hamid Hamid, Butt Butt, Jafri Jafri, Shukla Shukla, Tan Tan, Kim Kim, Saraya Saraya, Hu Hu, Sood Sood, Goyal Goyal, Midha Midha, Sahu Sahu, Lee Lee, Treeprasertsuk Treeprasertsuk, Thanapirom Thanapirom, Mandot Mandot, Shah Shah, Maghade Maghade, Lesmana Lesmana, Lesmana Lesmana, Ghazinyan Ghazinyan, Prasad Prasad, Dokmeci Dokmeci, Sollano Sollano, Abbas Abbas, Shrestha Shrestha, Lau Lau, Payawal Payawal, Shiha Shiha, Duseja Duseja, Taneja Taneja, Verma Verma, Rao Rao, Kulkarni Kulkarni, Sharma Sharma, Karim Karim, Dhiman Dhiman, Mishra Mishra, Alam Alam, Yokosuka Yokosuka, Chowdhury Chowdhury, Saraswat Saraswat, Kedarisetty Kedarisetty, Saigal Saigal, Yattoo Yattoo, Koshy Koshy, Patwa Patwa, Elbasiony Elbasiony, Rathi Rathi, Maharshi Maharshi, Dayal Dayal, Jha Jha, Kalista Kalista, Gani Gani, Yuen Yuen, Singh Singh, Singh Singh, Sargsyan Sargsyan, Huang Huang, Mukewar Mukewar, Xin Xin, Rajaram Rajaram, Panackel Panackel, Dadhich Dadhich, Sachdeva Sachdeva, Kumar Kumar, Behera Behera, Maji Maji, Kamani Kamani, Saithanyamurthi Saithanyamurthi, Varghese Varghese, Parikh Parikh, Javed Javed, Saraf Saraf, Choudhary Choudhary, Roy Roy, Goenka Goenka, Kalal Kalal, Devadas Devadas, Adali Adali, de Silva de Silva, Sarin Sarin,
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