Influence of type 2 diabetes mellitus and fasting insulin level on the risk of spontaneous peritonitis in patients with cirrhotic ascites

Xue WU; Yilian ZHANG; Ping LI; Yuqiang MI

doi:10.3969/j.issn.1001-5256.2022.07.017

Volume 38 Issue 7

Jul. 2022

Turn off MathJax

Article Contents

Abstract

References

Article Navigation > Journal of Clinical Hepatology > 2022 > 38(7): 1548-1553

PDF( 2419 KB)

Influence of type 2 diabetes mellitus and fasting insulin level on the risk of spontaneous peritonitis in patients with cirrhotic ascites

DOI: 10.3969/j.issn.1001-5256.2022.07.017

Xue WU¹,
Yilian ZHANG²,
Ping LI^{3
,
,
,},
Yuqiang MI³

1.
Clinical College of The Second People's Hospital, Tianjin Medical University, Tianjin 300070, China
2.
Department of Infectious Diseases, Baoding First Central Hospital, Baoding, Hebei 071000, China
3.
Tianjin Second People's Hospital, Tianjin Institute of Liver Disease, Tianjin 300110, China

Research funding:

Wang Bao'en Liver Fibrosis Research Fund of China Hepatitis Prevention foundation (2021038)

More Information

Corresponding author: LI Ping, tjlplxg@163.com (ORCID: 0000-0001-9930-6429)
Received Date: 2021-11-09
Accepted Date: 2022-01-29
Published Date: 2022-07-20

Abstract

Abstract

Objective To investigate the predictive factors for spontaneous bacterial peritonitis (SBP) in patients with decompensated cirrhotic ascites and the influence of type 2 diabetes mellitus (T2DM) and fasting insulin level on the risk of SBP. Methods A retrospective analysis was performed for the clinical data of patients who were diagnosed with liver cirrhosis and ascites in Tianjin Second People's Hospital from January 2013 to October 2018, and the patients were followed up for 1 year to record the onset time of SBP and the ending time of follow-up. Related data were obtained by searching the patients' medical records. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test or the Wilcoxon test was used for comparison of categorical data between two groups; a Cox regression analysis was used to investigate the factors for SBP in patients with cirrhotic ascites. The Kaplan-Meier method was used to plot survival curves, the log-rank test was used for survival difference analysis, and the receiver operating characteristic (ROC) curve was used to calculate the optimal cut-off value of fasting insulin. Results A total of 268 patients with cirrhotic ascites were enrolled, among whom 98 (36.6%) developed SBP. T2DM at baseline (hazard ratio [HR]=2.848, 95% confidence interval [CI]: 1.470-4.195, P < 0.05), baseline total bilirubin (TBil) (HR=1.004, 95%CI: 1.001-1.007, P < 0.05), and baseline percentage of neutrophils (N%) (HR=1.032, 95%CI: 1.010-1.055, P < 0.05) were independent predictive factors for SBP within 1 year. The Kaplan-Meier survival curve analysis showed that the patients with T2DM had a significantly higher 1-year cumulative incidence rate of SBP than those without T2DM (χ²=16.821, P < 0.05). Of all 268 patients, 88 (32.8%) had T2DM, and baseline fasting insulin ≥20.49 μU/mL (HR=2.757, 95%CI: 1.499-5.071, P < 0.05) significantly increased the risk of SBP. The Kaplan-Meier survival curve analysis showed that the fasting insulin ≥20.49 μU/mL group had a significantly higher risk of SBP within 1 year than the < 20.49 μU/mL group (χ²=13.297, P < 0.05). Conclusion The onset of SBP should be considered when patients with cirrhotic ascites have unexplained increases in TBil and N% or have T2DM or fasting insulin ≥20.49 μU/mL, and intervention measures can be adopted when necessary to delay disease progression and improve prognosis.
- Liver Cirrhosis,
- Ascites,
- Spontaneous Bacterial Peritonitis,
- Diabetes Mellitus, Type 2,
- Insulin

FullText(HTML)

References(20)

References

[1]	Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the management of ascites and complications in cirrhosis[J]. J Clin Hepatol, 2017, 33(10): 1847-1863. DOI: 10.3969/j.issn.1001-5256.2017.10.003. 中华医学会肝病学分会. 肝硬化腹水及相关并发症的诊疗指南[J]. 临床肝胆病杂志, 2017, 33(10): 1847-1863. DOI: 10.3969/j.issn.1001-5256.2017.10.003.
[2]	PIANO S, TONON M, ANGELI P. Changes in the epidemiology and management of bacterial infections in cirrhosis[J]. Clin Mol Hepatol, 2021, 27(3): 437-445. DOI: 10.3350/cmh.2020.0329.
[3]	PIANO S, ANGELI P. Bacterial infections in cirrhosis as a cause or consequence of decompensation?[J]. Clin Liver Dis, 2021, 25(2): 357-372. DOI: 10.1016/j.cld.2021.01.006.
[4]	SCHULTALBERS M, TERGAST TL, SIMON N, et al. Frequency, characteristics and impact of multiple consecutive nosocomial infections in patients with decompensated liver cirrhosis and ascites[J]. United European Gastroenterol J, 2020, 8(5): 567-576. DOI: 10.1177/2050640620913732.
[5]	CRISMALE JF, FRIEDMAN SL. Acute liver injury and decompensated cirrhosis[J]. Med Clin North Am, 2020, 104(4): 647-662. DOI: 10.1016/j.mcna.2020.02.010.
[6]	FERNÁNDEZ J, PRADO V, TREBICKA J, et al. Multidrug-resistant bacterial infections in patients with decompensated cirrhosis and with acute-on-chronic liver failure in Europe[J]. J Hepatol, 2019, 70(3): 398-411. DOI: 10.1016/j.jhep.2018.10.027.
[7]	ELKRIEF L, RAUTOU PE, SARIN S, et al. Diabetes mellitus in patients with cirrhosis: clinical implications and management[J]. Liver Int, 2016, 36(7): 936-948. DOI: 10.1111/liv.13115.
[8]	TANASE DM, GOSAV EM, COSTEA CF, et al. The intricate relationship between type 2 diabetes mellitus (T2DM), insulin resistance (IR), and nonalcoholic fatty liver disease (NAFLD)[J]. J Diabetes Res, 2020, 2020: 3920196. DOI: 10.1155/2020/3920196.
[9]	ZUWALA-JAGIELLO J, PAZGAN-SIMON M, SIMON K, et al. Serum endocan level in diabetes mellitus of patients with cirrhosis and risk of subsequent development of spontaneous bacterial peritonitis[J]. J Physiol Pharmacol, 2019, 70(3): 399-405. DOI: 10.26402/jpp.2019.3.06.
[10]	COMAN LI, COMAN OA, BǍDǍRǍU IA, et al. Association between liver cirrhosis and diabetes mellitus: A review on hepatic outcomes[J]. J Clin Med, 2021, 10(2): 262. DOI: 10.3390/jcm10020262.
[11]	LABENZ C, NAGEL M, KREMER WM, et al. Association between diabetes mellitus and hepatic encephalopathy in patients with cirrhosis[J]. Aliment Pharmacol Ther, 2020, 52(3): 527-536. DOI: 10.1111/apt.15915.
[12]	TAN ZJ, ZHAO J, LIU WX, et al. Analysis of pathogenic bacteris and factors affecting spontaneous bacterial peritonitis in patients with cirrhosis ascites[J]. Chin J Nosocomiol, 2019, 29(19): 2953-2956. DOI: 10.11816/cn.ci.2019-183023. 谭志洁, 赵静, 刘文兴, 等. 肝硬化腹水患者并发自发性细菌性腹膜炎病原菌与影响因素分析[J]. 中华医院感染学杂志, 2019, 29(19): 2953-2956. DOI: 10.11816/cn.ci.2019-183023.
[13]	LI YT, HUANG JR, PENG ML. Current status and prospects of spontaneous peritonitis in patients with cirrhosis[J]. Biomed Res Int, 2020, 2020: 3743962. DOI: 10.1155/2020/3743962.
[14]	LEE WG, WELLS CI, MCCALL JL, et al. Prevalence of diabetes in liver cirrhosis: A systematic review and meta-analysis[J]. Diabetes Metab Res Rev, 2019, 35(6): e3157. DOI: 10.1002/dmrr.3157.
[15]	TERGAST TL, LASER H, GERBEL S, et al. Association between type 2 diabetes mellitus, HbA1c and the risk for spontaneous bacterial peritonitis in patients with decompensated liver cirrhosis and ascites[J]. Clin Transl Gastroenterol, 2018, 9(9): 189. DOI: 10.1038/s41424-018-0053-0.
[16]	ABU-FREHA N, MICHAEL T, POUPKO L, et al. Spontaneous bacterial peritonitis among cirrhotic patients: Prevalence, clinical characteristics, and outcomes[J]. J Clin Med, 2021, 11(1): 227. DOI: 10.3390/jcm11010227.
[17]	JIANG P, DOU RC, CUI ZJ, et al. Value of albumin-bilirubin score combined with neutrophil count and procalcitonin in ascites in predicting spontaneous bacterial peritonitis in patients with cirrhotic ascites[J]. J Clin Hepatol, 2021, 37(9): 2097-2101. DOI: 10.3969/j.issn.1001-5256.2021.09.019. 江萍, 豆仁成, 崔子瑾, 等. 白蛋白-胆红素评分联合腹水中性粒细胞计数及降钙素原对肝硬化腹水患者发生自发性细菌性腹膜炎的预测价值[J]. 临床肝胆病杂志, 2021, 37(9): 2097-2101. DOI: 10.3969/j.issn.1001-5256.2021.09.019.
[18]	LIU H, ZHU P, NIE C, et al. The value of ascitic neutrophil gelatinase-associated lipocalin in decompensated liver cirrhosis with spontaneous bacterial peritonitis[J]. J Clin Lab Anal, 2020, 34(6): e23247. DOI: 10.1002/jcla.23247.
[19]	ROSENBLATT R, ATTEBERRY P, TAFESH Z, et al. Uncontrolled diabetes mellitus increases risk of infection in patients with advanced cirrhosis[J]. Dig Liver Dis, 2021, 53(4): 445-451. DOI: 10.1016/j.dld.2020.10.022.
[20]	TIAN CY, HU H, ZHANG GY, et al. Influence of glucose metabolism disorder on complications associated with liver cirrhosis[J]. J Clin Hepatol, 2021, 37(5): 1197-1200. DOI: 10.3969/j.issn.1001-5256.2021.05.046. 田彩云, 胡晗, 张国远, 等. 糖代谢紊乱对肝硬化相关并发症的影响[J]. 临床肝胆病杂志, 2021, 37(5): 1197-1200. DOI: 10.3969/j.issn.1001-5256.2021.05.046.