Liu ZJ, Yan YJ, Weng HL, Ding HG. Type 2 diabetes mellitus increases liver transplant-free mortality in patients with cirrhosis: A systematic review and meta-analysis. World J Clin Cases 2021; 9(20): 5514-5525 [PMID: 34307604 DOI: 10.12998/wjcc.v9.i20.5514]
Corresponding Author of This Article
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
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
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
ARTICLE HIGHLIGHTS
Research background
Type 2 diabetes mellitus (T2DM) and liver cirrhosis have become the major threats to people’s health globally. However, whether the presence of T2DM in patients with cirrhosis can increase mortality and other liver-related complications is also controversial.
Research motivation
A comprehensive systemic review and meta-analysis can help conclude the relative article results and help doctors to make clinical decisions easily.
Research objectives
The aim of this meta-analysis was to clarify the mortality and related risk factors as well as complications in cirrhotic patients with T2DM.
Research methods
Studies were enrolled following specific criteria. The primary endpoints were defined as liver transplant-free mortality and hepatocellular carcinoma (HCC) incidence. Secondary endpoints included ascites, spontaneous bacterial peritonitis (SBP), variceal bleeding, and hepatic encephalopathy (HE). Studies results were combined using RevMan software.
Research results
Meta-analysis indicated that T2DM was significantly associated with an increased risk of liver transplant-free mortality [odds ratios (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).
Research conclusions
T2DM patients 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.
Research perspectives
More attention should be paid to T2DM in liver cirrhosis patients to improve better prognosis of these patients.
