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. 2018 Sep 24;9(9):189.
doi: 10.1038/s41424-018-0053-0.

Association Between Type 2 Diabetes Mellitus, HbA1c and the Risk for Spontaneous Bacterial Peritonitis in Patients with Decompensated Liver Cirrhosis and Ascites

Tammo L Tergast  1 , Hans Laser  2 , Svetlana Gerbel  2 , Michael P Manns  1   3   4 , Markus Cornberg  5   6   7 , Benjamin Maasoumy  8   9
Affiliations

Association Between Type 2 Diabetes Mellitus, HbA1c and the Risk for Spontaneous Bacterial Peritonitis in Patients with Decompensated Liver Cirrhosis and Ascites

Tammo L Tergast et al. Clin Transl Gastroenterol. .

Abstract

Introduction: Type 2 diabetes mellitus (DM) is a frequent comorbidity among patients with liver cirrhosis. However, data regarding the impact of DM on spontaneous bacterial peritonitis (SBP) are quite limited. Our aim was to analyze the impact of DM and HbA1c values on the incidence of SBP and mortality in patients with liver cirrhosis and ascites.

Methods: A number of 475 consecutive patients with liver cirrhosis and ascites were analyzed. Presence of DM as well as HbA1c was assessed at the time of the first paracentesis. Patients were followed up for a mean of 266 days. Primary endpoints were SBP development and mortality.

Results: Overall, 118 (25%) patients were diagnosed with DM. DM patients had an increased risk for developing a SBP during follow-up (HR: 1.51; p = 0.03). SBP incidence was particularly high in DM patients with HbA1c values ≥6.4%, significantly higher than in DM patients with HbA1c values <6.4% (HR: 4.21; p = 0.0002). Of note, DM patients with HbA1c <6.4% at baseline had a similar risk for SBP as those without DM (HR: 0.93; p = 0.78, respectively). After excluding all patients who were eligible for secondary antibiotic prophylaxis, HbA1c ≥6.4% but neither bilirubin nor ascites protein level were associated with primary SBP development in the multivariate analysis (p = 0.003).

Conclusions: Individuals with liver cirrhosis and concomitant DM have a higher risk for developing a SBP. HbA1c values may be useful to further stratify the risk for SBP among DM patients, which may help to identify those who benefit from antibiotic prophylaxis.

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Conflict of interest statement

Guarantor of the article: Tammo L. Tergast

Specific author contribution:T.L.T.: Study concept and design, data acquisition, analysis, and interpretation of the data and drafting of the manuscript. H.L.: Patient selection and data acquisition, critical revision of the manuscript for important intellectual content. S.G.: Patient selection and data acquisition, critical revision of the manuscript for important intellectual content. M.P.M.: Data interpretation, critical revision of the manuscript for important intellectual content. M.C.: Interpretation of the data, drafting the manuscript, critical revision of the manuscript for important intellectual content, supervision. B.M.: Study concept and design, interpretation of the data, drafting the manuscript, critical revision of the manuscript, supervision.

Financial support: T.L.T.and this study were supported by the ‘KlinStrucMed’ Programme funded by the Else Kröner-Fresenius Foundation.

Potential competing interests: The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1. SBP incidence in patients with and without DM.
p-values were calculated with the log-rank test
Fig. 2
Fig. 2. SBP incidence in patients with DM and HbA1c ≥6.4% or <6.4% and no-DM.
p-values were calculated with the log-rank test
Fig. 3
Fig. 3. SBP incidence in patients with DM and HbA1c ≥6.4% or <6.4% and no-DM.
All patients with history of SBP were excluded in this analysis.p-values were calculated with the log-rank test
Fig. 4
Fig. 4
Overall survival in patients with and without DM (a) and overall survival in patients with HbA1c values ≥6.4%,  6.4% and no-DM (b). p-values were calculated with the log-rank test
Fig. 5
Fig. 5. Overall mortality in patients with and without DM after the diagnosis of SBP.
p-values were calculated with the log-rank test
See this image and copyright information in PMC

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