Diabetes Is Associated with Hepatic Encephalopathy in Patients with HCV-Related Cirrhosis

Patients with advanced liver cirrhosis may develop hepatic encephalopathy, or brain damage. One factor contributing to encephalopathy is an increased level of ammonia, produced by bacteria in the gut.

Constipation may lead to hepatic coma in patients with liver disease. Because diabetes mellitus may be associated with delayed gastrointestinal transit, researchers with the Center for Liver Disease and Transplantation at Weill Cornell Medical Center conducted a study to assess whether diabetes increased the likelihood and severity of hepatic encephalopathy in patients with hepatitis C virus (HCV)-related cirrhosis.

The cross-sectional study, reported in the July 2006 American Journal of Gastroenterology, included 65 patients (50 men, 15 women) with HCV-related cirrhosis attending a liver transplantation clinic.

The researchers assessed the frequency and severity of hepatic encephalopathy (absent, mild or severe) in diabetic and non-diabetic patients. Clinical severity of cirrhosis and results of neuropsychometric testing in diabetic and non-diabetic patients with mild and severe hepatic encephalopathy were compared.

Results

54 patients (83%) developed hepatic encephalopathy (33 mild, 21 severe).

20 patients (31%) had diabetes.

Hepatic encephalopathy was present in 19 patients with diabetes (95%) and in 35 non-diabetic patients (78%) (P = 0.087).

Severity of hepatic encephalopathy was greater in diabetic patients (35% mild, 60% severe) compared with non-diabetic patients (58% mild, 20% severe) (P = 0.007).

In both the mild and severe hepatic encephalopathy categories, severity of liver disease in diabetic patients was otherwise milder than in non-diabetic patients.

Conclusion

"Diabetic patients with HCV cirrhosis have more severe hepatic encephalopathy," the authors concluded. "Diabetic patients have severe hepatic encephalopathy at earlier stages of biochemical decompensation and portal hypertension compared with non-diabetic patients."

8/18/06

Reference
S H Sigal, C M Stanca, N Kontorinis, and others. Diabetes mellitus is associated with hepatic encephalopathy in patients with HCV cirrhosis. American Journal of Gastroenterology 101(7): 1490-1496. July 2006.