Diabetes Mellitus Is Associated with Hepatic.pdf

American Journal of Gastroenterology ISSN 0002-9270 C? 2006 by Am. Coll. of Gastroenterology doi: 10.1111/j.1572-0241.2006.00649.x Published by Blackwell Publishing Diabetes Mellitus Is Associated with Hepatic Encephalopathy in Patients with HCV Cirrhosis Samuel H. Sigal, M.D.,1 Carmen M. Stanca, M.D.,2 Nickolas Kontorinis, M.D.,2 Carol Bodian, Dr. Ph.,3,4 and Elizabeth Ryan, M.D.5 1Center for Liver Disease and Transplantation, New York Weill Cornell Medical Center, New York; Departments of 2Medicine, 3Biomathematical Sciences, 4Anesthesiology, and 5Psychiatry, Mount Sinai School of Medicine, New York OBJECTIVES: An increased ammonia level of gut bacterial origin is an important mediator in the pathogenesis of hepatic encephalopathy (HE), and constipation is a frequent precipitant of hepatic coma. Because diabetes mellitus (DM) may be associated with delayed gastrointestinal transit, we speculated that its presence in patients with HCV-related cirrhosis would predispose to and exacerbate HE. METHODS: Sixty-five patients (50 men, 15 women) with HCV-related cirrhosis attending a liver transplantation clinic were assessed for severity of liver disease and presence of DM in a cross-sectional study. A modified Child-Pugh score that excluded HE was calculated. Frequency and severity of HE (absent, mild, and severe) in diabetic and nondiabetic patients were assessed. Clinical severity of cirrhosis and results of neuropsychometric testing in diabetic and nondiabetic patients with mild and severe HE were compared. RESULTS: Fifty-four patients (83%) had HE (33 mild, 21 severe). Twenty patients (31%) had DM. HE was present in 19 (95%) patients with diabetes and 35 (78%) patients without diabetes (p = 0.087). Severity of HE was greater in diabetic (35% mild, 60% severe) than in nondiabetic patients (58% mild, 20% severe) (p = 0.007). In both the mild and severe HE categories, severity of liver disease in diabetic patients was otherwise milder than in the nondiabetic patients. C