Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2021; 9(20): 5514-5525
Published online Jul 16, 2021. doi: 10.12998/wjcc.v9.i20.5514
Type 2 diabetes mellitus increases liver transplant-free mortality in patients with cirrhosis: A systematic review and meta-analysis
Zi-Jin Liu, Yi-Jie Yan, Hong-Lei Weng, Hui-Guo Ding
Zi-Jin Liu, Yi-Jie Yan, Hui-Guo Ding, Department of Gastroenterology and Hepatology, Beijing You’an Hospital Affiliated to Capital Medical University, Beijing 100069, China
Hong-Lei Weng, Department of Medicine II, Section Molecular Hepatology, Medical Faculty Mannheim, Heidelberg University, Mannheim 68167, Germany
Author contributions: Liu ZJ and Yan YJ searched the literature and collected the data; Liu ZJ wrote the manuscript; Ding HG designed the project and edited the manuscript; Weng HL helped polish the language of the manuscript; all the authors have read and approved the manuscript.
Conflict-of-interest statement: The authors declare no conflict of interest for this article.
PRISMA 2009 Checklist statement: This systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hui-Guo Ding, MD, Chief Doctor, Director, Department of Gastroenterology and Hepatology, Beijing You’an Hospital Affiliated to Capital Medical University, No. 8 Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China. dinghuiguo@ccmu.edu.cn
Received: February 9, 2021
Peer-review started: February 9, 2021
First decision: April 19, 2021
Revised: April 27, 2021
Accepted: May 20, 2021
Article in press: May 20, 2021
Published online: July 16, 2021
Abstract
BACKGROUND

The impact of type 2 diabetes mellitus (T2DM) on the prognosis and complications of liver cirrhosis is not fully clarified.

AIM

To clarify the mortality and related risk factors as well as complications in cirrhotic patients with T2DM.

METHODS

We searched PubMed, EMBASE, and the Cochrane Library from their inception to December 1, 2020 for cohort studies comparing liver transplant-free mortality, hepatocellular carcinoma (HCC), ascites, spontaneous bacterial peritonitis (SBP), variceal bleeding, and hepatic encephalopathy (HE) in cirrhotic patients with vs without T2DM. Odds ratios (ORs) were combined by using fixed-effects or random-effects models with RevMan software.

RESULTS

The database search generated a total of 17 cohort studies that met the inclusion criteria. Among these studies, eight reported the risk of mortality, and eight reported the risk of HCC. Three studies provided SBP rates, and two documented ascites rates. Four articles focused on HE rates, and three focused on variceal bleeding rates. Meta-analysis indicated that T2DM was significantly associated with an increased risk of liver transplant-free mortality [OR: 1.28, 95% confidence intervals (CI): 1.16-1.41, P < 0.0001] and HCC incidence (OR: 1.82, 95%CI: 1.32-2.51, P = 0.003). The risk of SBP was not significantly increased (OR: 1.16 95%CI: 0.86-1.57, P = 0.34). Additionally, T2DM did not significantly increase HE (OR: 1.31 95%CI: 0.97-1.77, P = 0.08), ascites (OR: 1.11 95%CI: 0.84-1.46, P = 0.46), and variceal bleeding (OR: 1.34, 95%CI: 0.99-1.82, P = 0.06).

CONCLUSION

The findings suggest that cirrhotic patients with T2DM have a poor prognosis and high risk of HCC. T2DM may not be associated with an increased risk of SBP, variceal bleeding, ascites, or HE in cirrhotic patients with T2DM.

Keywords: Diabetes mellitus, Mortality, Liver cirrhosis, Hepatocellular carcinoma, Meta-analysis

Core Tip: No consensus is available in the literature about whether type 2 diabetes mellitus (T2DM) can influence the prognosis and complications of liver cirrhosis. This is the first systematic review and meta-analysis comparing the mortality, hepatocellular carcinoma, hepatic encephalopathy, ascites, esophageal varices bleeding, and spontaneous bacterial peritonitis rates between T2DM and non-T2DM cirrhotic patients.