Hypoglycemia is associated with increased mortality in patients with acute decompensated liver cirrhosis

Pfortmüller, Carmen; Wiemann, Christoph; Funk, Georg-Christian; Leichtle, Alexander Benedikt; Fiedler, Martin; Exadaktylos, Aristomenis; Lindner, Gregor (2014). Hypoglycemia is associated with increased mortality in patients with acute decompensated liver cirrhosis. Journal of critical care, 29(2), 316.e7-316.e12. Elsevier 10.1016/j.jcrc.2013.11.002

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PRINCIPALS The liver plays an important role in glucose metabolism, in terms of glucolysis and gluconeogenesis. Several studies have shown that hyperglycemia in patients with liver cirrhosis is associated with progression of the liver disease and increased mortality. However, no study has ever targeted the influence of hypoglycemia. The aim of this study was to assess the association of glucose disturbances with outcome in patients presenting to the emergency department with acute decompensated liver cirrhosis. METHODS Our retrospective data analysis comprised adult (≥16 years) patients admitted to our emergency department between January 1, 2002, and December 31, 2012, with the primary diagnosis of decompensated liver cirrhosis. RESULTS A total of 312 patients were eligible for study inclusion. Two hundred thirty-one (74.0%) patients were male; 81 (26.0%) were female. The median age was 57 years (range, 51-65 years). Overall, 89 (28.5%) of our patients had acute glucose disturbances; 49 (15.7%) of our patients were hypoglycemic and 40 (12.8%) were hyperglycemic. Patients with hypoglycemia were significantly more often admitted to the intensive care unit than hyperglycemic patients (20.4% vs 10.8%, P < .015) or than normoglycemic patients (20.4% vs 10.3%, P < .011), and they significantly more often died in the hospital (28.6% hypoglycemic vs 7.5% hyperglycemic, P < .024; 28.6% hypoglycemic vs 10.3% normoglycemic P < .049). Survival analysis showed a significantly lower estimated survival for hypoglycemic patients (36 days) than for normoglycemic patients (54 days) or hyperglycemic patients (45 days; hypoglycemic vs hyperglycemic, P < .019; hypoglycemic vs normoglycemic, P < .007; hyperglycemic vs normoglycemic, P < .477). CONCLUSION Hypoglycemia is associated with increased mortality in patients with acute decompensated liver cirrhosis. It is not yet clear whether hypoglycemia is jointly responsible for the increased short-term mortality of patients with acute decompensated liver cirrhosis or is only a consequence of the severity of the disease or the complications.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Institute of Clinical Chemistry
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > University Emergency Center
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine

UniBE Contributor:

Pfortmüller, Carmen; Leichtle, Alexander Benedikt; Fiedler, Martin; Exadaktylos, Aristomenis and Lindner, Gregor

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0883-9441

Publisher:

Elsevier

Language:

English

Submitter:

Patricia Rajaonina

Date Deposited:

28 Mar 2014 15:08

Last Modified:

09 Nov 2015 10:53

Publisher DOI:

10.1016/j.jcrc.2013.11.002

PubMed ID:

24332992

Uncontrolled Keywords:

Decompensated liver cirrhosis, Glucose disturbance, Hypoglycemia, Mortality

BORIS DOI:

10.7892/boris.47281

URI:

https://boris.unibe.ch/id/eprint/47281

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