Uncontrolled diabetes mellitus, old age worsen outcomes in advanced cirrhosis

In patients with advanced cirrhosis, uncontrolled diabetes mellitus (DM) appears to increase the risk of infections, a recent study has found. When combined with old age, the conditions also hurt survival outlook.

Drawing from the National Inpatient Sample of the USA, the researchers identified 3,104,310 patients with advanced cirrhosis, of whom 29.2 percent (n=906,559) were diagnosed with DM and subsequently included in the present study. The main outcome of interest was bacterial infection, while mortality among the elderly (age ≥70 years) was set as a secondary endpoint.

Data were collected from 1998 to 2014, during which time the prevalence of DM increased from 21.3 percent to 38.4 percent. On the other hand, the rate of uncontrolled DM jumped from 16.2 percent to 9.4 percent in 2004, before slightly rising back to 13.2 percent by 2014; the annual percent change of uncontrolled DM was –0.1 percent.

Overall, 29.1 percent of participants had bacterial infections, which was significantly more common among those with vs without uncontrolled DM (34.2 percent vs 28.4 percent; p<0.001). Multiple infections, too, occurred significantly more frequently among those with uncontrolled DM (9.0 percent vs 6.3 percent; p<0.001).

Multivariable logistic regression analysis found that uncontrolled DM increased the risk of bacterial infections by more than 30 percent (odds ratio [OR], 1.33, 95 percent confidence interval [CI], 1.29–1.37; p<0.001).

In a sub-analysis of 243,864 elderly patients, the researchers found that while uncontrolled DM was rarer (8.9 percent vs 13.3 percent; p<0.001), bacterial infections were much more common (31.4 percent vs 28.2 percent; p<0.001).

The combination of old age and uncontrolled DM increased the likelihood of bacterial infections by over 40 percent (OR, 1.41, 95 percent CI, 1.33–1.50; p<0.001), and of all-cause mortality by more than 60 percent (OR, 1.62, 95 percent CI, 1.46–1.81; p<0.001).