Abstract：
OBJECTIVE: Disorders of glucose metabolism, such as impaired glucose tolerance (IGT) and diabetes mellitus (DM), frequently occur in cirrhosis. We aimed to evaluate who needs to be undertaken a 75-g oral glucose tolerance test (OGTT) to find underlying subclinical diabetes.
METHODS: This prospective study included 713 patients with either compensated (Child-Turcotte-Pugh [CTP] class A) or decompensated cirrhosis (CTP class B/C) without previous DM history. All patients underwent a 75-g OGTT. The patients were divided into three groups: normal glucose tolerance (NGT), IGT, and newly diagnosed DM (subclinical DM).
RESULTS: Among 713 patients, NGT was diagnosed in 139 (19.5%), IGT in 252 (35.3%), and subclinical DM in 322 (45.2%) patients, respectively. During a median follow-up period of 42.0 months, the cumulative survival rates of patients were as follows: NGT, 75.6%; IGT, 57.6%; and subclinical DM, 54.8%. Overall, IGT (adjusted hazard ratio [aHR], 1.605; 95% confidence interval [CI] = 1.009-2.553; P = 0.046) and subclinical DM (aHR, 1.840; 95% CI = 1.183-2.861; P = 0.001) were identified as independent predictors of mortality. In patients with compensated cirrhosis (n = 415), neither IGT nor subclinical DM conferred a higher mortality risk. However, among patients with decompensated cirrhosis (n = 298), those with IGT (aHR, 2.394; P = 0.015) and subclinical DM (aHR, 2.211; P = 0.022) showed a survival rate worse than those with NGT. In addition, subclinical DM was identified as an independent risk factor for infection (aHR, 2.508; P = 0.007).
CONCLUSIONS: IGT and subclinical diabetes by OGTT are associated with an unfavorable prognosis in cirrhosis, and the effect is pronounced in the decompensated state.
RESULTS: gov, Number NCT04828512 (https://clinicaltrials.gov/ct2/show/NCT04828512).
METHODS: This prospective study included 713 patients with either compensated (Child-Turcotte-Pugh [CTP] class A) or decompensated cirrhosis (CTP class B/C) without previous DM history. All patients underwent a 75-g OGTT. The patients were divided into three groups: normal glucose tolerance (NGT), IGT, and newly diagnosed DM (subclinical DM).
RESULTS: Among 713 patients, NGT was diagnosed in 139 (19.5%), IGT in 252 (35.3%), and subclinical DM in 322 (45.2%) patients, respectively. During a median follow-up period of 42.0 months, the cumulative survival rates of patients were as follows: NGT, 75.6%; IGT, 57.6%; and subclinical DM, 54.8%. Overall, IGT (adjusted hazard ratio [aHR], 1.605; 95% confidence interval [CI] = 1.009-2.553; P = 0.046) and subclinical DM (aHR, 1.840; 95% CI = 1.183-2.861; P = 0.001) were identified as independent predictors of mortality. In patients with compensated cirrhosis (n = 415), neither IGT nor subclinical DM conferred a higher mortality risk. However, among patients with decompensated cirrhosis (n = 298), those with IGT (aHR, 2.394; P = 0.015) and subclinical DM (aHR, 2.211; P = 0.022) showed a survival rate worse than those with NGT. In addition, subclinical DM was identified as an independent risk factor for infection (aHR, 2.508; P = 0.007).
CONCLUSIONS: IGT and subclinical diabetes by OGTT are associated with an unfavorable prognosis in cirrhosis, and the effect is pronounced in the decompensated state.
RESULTS: gov, Number NCT04828512 (https://clinicaltrials.gov/ct2/show/NCT04828512).
摘要：
目的：糖代谢紊乱，如糖耐量减低（IGT）和糖尿病（DM），常见于肝硬化。我们旨在评估谁需要进行75克口服葡萄糖耐量试验（OGTT）以发现潜在的亚临床糖尿病。
方法：这项前瞻性研究包括713例代偿性肝硬化（Child-Turcotte-Pugh[CTP]A级）或失代偿性肝硬化（CTPB/C级）患者，无DM病史。所有患者均接受75gOGTT。将患者分为三组:正常糖耐量(NGT)、IGT,和新诊断的DM（亚临床DM）。
结果：在713名患者中，NGT被诊断为139（19.5%），IGT为252（35.3%），322例（45.2％）患者的亚临床DM，分别。在42.0个月的中位随访期内，患者的累积生存率如下：NGT，75.6%;IGT,57.6%；亚临床DM，54.8%。总的来说,IGT(调整后的危险比[aHR]，1.605；95%置信区间[CI]=1.009-2.553；P=0.046）和亚临床DM（aHR，1.840；95%CI=1.183-2.861；P=0.001）被确定为死亡率的独立预测因子。在代偿性肝硬化患者中（n=415），IGT和亚临床DM均未导致更高的死亡风险.然而,失代偿期肝硬化患者（n=298），那些有IGT(AHR，2.394；P=0.015）和亚临床DM（aHR，2.211；P=0.022）显示生存率比NGT低。此外,亚临床DM被确定为感染的独立危险因素(aHR，2.508；P=0.007）。
结论：IGT和OGTT引起的亚临床糖尿病与肝硬化的不良预后相关，在失代偿状态下效果明显。
结果：政府，编号NCT04828512(https://clinicaltrials.gov/ct2/show/NCT04828512)。
方法：这项前瞻性研究包括713例代偿性肝硬化（Child-Turcotte-Pugh[CTP]A级）或失代偿性肝硬化（CTPB/C级）患者，无DM病史。所有患者均接受75gOGTT。将患者分为三组:正常糖耐量(NGT)、IGT,和新诊断的DM（亚临床DM）。
结果：在713名患者中，NGT被诊断为139（19.5%），IGT为252（35.3%），322例（45.2％）患者的亚临床DM，分别。在42.0个月的中位随访期内，患者的累积生存率如下：NGT，75.6%;IGT,57.6%；亚临床DM，54.8%。总的来说,IGT(调整后的危险比[aHR]，1.605；95%置信区间[CI]=1.009-2.553；P=0.046）和亚临床DM（aHR，1.840；95%CI=1.183-2.861；P=0.001）被确定为死亡率的独立预测因子。在代偿性肝硬化患者中（n=415），IGT和亚临床DM均未导致更高的死亡风险.然而,失代偿期肝硬化患者（n=298），那些有IGT(AHR，2.394；P=0.015）和亚临床DM（aHR，2.211；P=0.022）显示生存率比NGT低。此外,亚临床DM被确定为感染的独立危险因素(aHR，2.508；P=0.007）。
结论：IGT和OGTT引起的亚临床糖尿病与肝硬化的不良预后相关，在失代偿状态下效果明显。
结果：政府，编号NCT04828512(https://clinicaltrials.gov/ct2/show/NCT04828512)。
