Frédéric, Clarembeau
[UCL]
Stärkel, Peter
[UCL]
Géraldine, Dahlqvist
[UCL]
Leclerq, Isabelle
[UCL]
Lanthier, Nicolas
[UCL]
Background and aims: Cirrhosis is a frequent disease inducing high morbidity and mortality. Available data suggest that cirrhosis could be associated with insulin resistance (IR) and diabetes mellitus (DM). We performed a prospective study to answer the following questions: is cirrhosis associated with IR and DM; is IR, independently from diabetes, associated with cirrhosis severity; are the different etiologies of cirrhosis associated with different levels of IR and finally does glucose homeostasis alterations correlate with higher morbidity and mortality? Patients and methods: From February 2016 to September 2017, patients seen at the hepatology clinic were prospectively enrolled in this study. At inclusion, a complete assessment of glucose homeostasis was performed on fasted venous blood to calculate the homeostasis model assessment of insulin resistance (HOMA). Patients were separated in several cohorts, based on the presence or absence of cirrhosis (cirrhosis versus controls), absence or presence of treated DM and IR (HOMA > 2.5). We recorded the cause of the underlying liver disease and the number of hospitalizations due to cirrhosis complication and death. Results: 107 patients with cirrhosis and 20 controls accepted to participate in this study. Both groups were comparable in terms of age, body mass index, creatinine and triglyceride levels but cirrhotic patients had significant lower levels of albumin, platelets and cholesterol and significant higher levels of AST and INR. There were 43% of patients with DM within the cirrhotic group compared with 25% of patients within the control group. In cirrhotic patients without DM, IR was more pronounced than in control patients (mean HOMA-IR: 5.9 ± 4.7 vs 2.8 ± 2.2, p=0.004). We also found that IR was correlated with the severity of cirrhosis based on the MELD score (r=0.54, p<0.001). Different etiologies of cirrhosis were shown to exhibit different levels of IR (p=0.001). DM was most prevalent in the NAFLD cirrhotic group with 75.6 % of the patients treated for diabetes within this group. IR and DM were also associated with an elevated morbidity and mortality (p=0.005). Conclusion: IR is more frequent in cirrhotic patients. The level of IR is correlated with cirrhosis severity and is associated with a higher rate of complications and a lower survival within the cirrhotic group. Whether an early diagnosis of IR in this population and an appropriate treatment will reduce such complications remains to be defined.
Bibliographic reference |
Frédéric, Clarembeau ; Stärkel, Peter ; Géraldine, Dahlqvist ; Leclerq, Isabelle ; Lanthier, Nicolas. Insulin resistance in cirrhotic patients: results from a large prospective study.European Association for the Study of the Liver (EASL) annual liver meeting (Vienna, du 10/04/2019 au 14/04/2019). In: Journal of Hepatology, Vol. 70, no.1, p. e658-e659 (2019) |
Permanent URL |
http://hdl.handle.net/2078.1/226034 |