Effect of type 2 diabetic mellitus in the prognosis of acute-on-chronic liver failure patients in China

Table 1 Demographic characteristics and clinical features of the patients between diabetic mellitus and non-diabetic mellitus

	DM (yes) (n = 38)	DM (no) (n = 184)	P value
Age (yr)	56.32 ± 14.23	49.16 ± 12.84	0.002
Gender, n (%)			0.309
Male	28 (73.68)	149 (80.98)
Female	10 (26.32)	35 (19.02)
Cause of disease, n (%)			0.201
Hepatitis B virus	26 (68.42)	139 (75.54)
Hepatitis B virus + other	5 (13.16)	20 (10.87)
Alcohol	2 (5.26)	15 (8.15)
Others	5 (13.16)	10 (5.44)
WBC (109/L)	6.17 ± 4.03	7.35 ± 3.58	0.07
RBC (1012/L)	3.68 ± 0.87	3.94 ± 0.84	0.084
Hb (g/L)	117.21 ± 24.71	121.95 ± 23.13	0.257
PLT (109/L)	100.34 ± 42.20	118.79 ± 59.09	0.069
PT (s)	23.01 ± 5.38	24.45 ± 6.95	0.229
INR	1.97 ± 0.45	2.10 ± 0.59	0.229
ALT (U/L)	396.08 ± 448.56	560.36 ± 693.06	0.163
AST (U/L)	365.95 ± 391.18	419.99 ± 513.42	0.541
γ-GGT (U/L)	174.16 ± 305.61	137.57 ± 127.33	0.231
TBIL (μmol/L)	320.71 ± 141.31	309.56 ± 134.00	0.644
ALB (g/L)	29.25 ± 4.51	30.73 ± 4.03	0.045
Scr (μmol/L)	56.37 ± 22.00	63.45 ± 27.28	0.134
BUN (mmol/L)	3.94 ± 2.65	4.25 ± 2.98	0.56
TCHO (mmol/L)	2.67 ± 0.81	2.65 ± 1.05	0.919
TG (mmol/L)	1.45 ± 0.67	1.26 ± 0.70	0.124
Na+ (mmol/L)	136.98 ± 3.97	136.86 ± 4.43	0.878
K+ (mmol/L)	3.90 ± 0.46	4.08 ± 0.58	0.072
AMON (μmol/L)	64.40 ± 40.39	71.60 ± 41.85	0.332
AFP (ng/mL)	118.63 ± 202.80	128.19 ± 192.02	0.784
BMI (kg/m2)	24.99 ± 3.32	22.78 ± 3.03	< 0.001
FBG (mmol/L)	5.34 ± 1.87	3.83 ± 1.07	< 0.001
Scoring systems
CTP	10.79 ± 1.49	10.40 ± 1.35	0.115
MELD	19.38 ± 4.52	20.74 ± 5.06	0.128
MELD-Na	20.89 ± 5.00	22.27 ± 6.84	0.239
Death, n (%)	25 (65.79)	69 (37.5)	0.001

γ-GGT: Gamma-glutamyl transpeptidase; AFP: Alpha fetal protein; ALB: Albumin; ALT: Alanine aminotransferase; AMMON: Ammonia; AST: Aspartate aminotransferase; BMI: Body mass index; BUN: Blood urea nitrogen; CTP: Child-Turcotte-Pugh; DM: Diabetic mellitus; FBG: Fasting blood-glucose; HB: Hemoglobin; INR: International normalized ratio; K⁺: Kalium; MELD: Model for End-Stage Liver Disease; MELD-Na: Model for End-Stage Liver Disease with serum sodium; Na⁺: Natriumion; PLT: Platelet count; PT: Prothrombin time; Scr: Serum creatinine; TBIL: Total bilirubin; TCHO: Total cholesterol; TG: Triglyceride; RBC: Red blood cell; WBC: White blood cell.

Table 2 The incidence of complications between diabetic mellitus and non-diabetic mellitus patients with acute-on-chronic liver failure

	DM (yes) (n = 38)	DM (no) (n = 184)	P value
Ascites, n (%)	34 (89.47)	139 (75.54)	0.271
Mild	21 (55.26)	80 (43.48)
Moderate	5 (13.16)	26 (14.13)
Severe	8 (21.05)	33 (17.93)
HE, n (%)	4 (10.53)	5 (2.72)	0.026
Grade (1-2)	4 (10.53)	3 (1.63)
Grade (3-4)	0 (0)	2 (1.09)
HRS, n (%)	4 (10.53)	12 (6.52)	0.385
AUGIB, n (%)	3 (7.89)	4 (2.17)	0.066
SBP, n (%)	13 (34.21)	25 (13.59)	0.038
Other infections, n (%)	17 (44.74)	52 (28.26)	0.046
Lung	13 (34.21)	43 (23.37)
Urinary	1 (2.63)	5 (2.72)
Blood	2 (5.26)	2 (1.09)
Cholecyst	1 (2.63)	2 (1.09)

Ascites mild: The depth of abdomen was < 3 cm; Ascites moderate: The depth of the middle of the abdomen was 3-10 cm; Ascites severe: The depth of the middle of the abdomen was > 10 cm; HE: Hepatic encephalopathy; HE grade 1: Patients showed a lack of attention and some subtle personality changes; HE grade 2: The most intriguing finding was disorientation for time combined; HE grade 3: Patients were stuporous but responded to stimuli; HE grade 4: Patients were in coma. AUGIB: Acute upper gastrointestinal bleeding; AUGIH: Acute upper gastrointestinal hemorrhage; HRS: Hepatorenal syndrome; SBP: Spontaneous peritonitis.

Table 3 Factors associated with the survival time of acute-on-chronic liver failure patients based on Cox proportional hazards regression

	Univariate		Multivariate
	HR (95%CI)	P value	HR (95%CI)	P value
Gender	0.58 (0.37-0.91)	0.019	0.535 (0.332-0.861)	0.01
Age (yr)	1 (0.99-1)	0.23
WBC (109/L)	1 (0.99-1.1)	0.12
RBC (1012/L)	0.73 (0.57-0.92)	0.009
Hb (g/L)	0.99 (0.98-1)	0.01
PLT (109/L)	0.99 (0.99-1)	0.021
PT (s)	1.1 (1-1.1)	< 0.001
INR	1.9 (1.4-2.5)	< 0.001	2.725 (1.949-3.811)	< 0.001
ALT (U/L)	1 (1-1)	0.53
AST (U/L)	1 (1-1)	0.8
γ-GGT (U/L)	1 (1-1)	0.93
TBIL (μmol/L)	1 (1-1)	0.77
ALB (g/L)	0.95 (0.9-1)	0.079
Scr (μmol/L)	1 (1-1)	0.15
BUN (mmol/L)	1.1 (1-1.2)	0.021	1.095 (1.025-1.170)	0.0069
TCHO (mmol/L)	1 (0.85-1.3)	0.76	1.220 (1.006-1.170)	0.0436
TG (mmol/L)	0.78 (0.55-1.1)	0.18
Na+ (mmol/L)	0.94 (0.9-0.98)	0.005
K+ (mmol/L)	0.83 (0.58-1.2)	0.34
AMON (μmol/L)	1 (0.99-1)	0.64
AFP (ng/ml)	1 (1-1)	0.075
BMI (kg/m2)	0.99 (0.93-1.1)	0.7
FBG (mmol/L)	0.58 (0.39-0.87)	0.009	0.842 (0.719-0.986)	0.0325
CTP	1.7 (1-2.9)	0.042
MELD	1.1 (1-1.1)	0.02
MELD-Na	1 (1-1.1)	0.002
DM	2.4 (1.5-3.7)	< 0.001	3.17 (1.82-5.523)	< 0.001
Ascites	1.2 (1-1.5)	0.036
HE	1.3 (0.65-2.5)	0.48
HRS	3.3 (1.9-5.8)	< 0.001	2.71 (1.513-4.857)	0.001
AUGIB	2.6 (1.1-5.9)	0.027	2.444 (1.037-5.76)	0.041
SBP	2.5 (1.6-3.9)	< 0.001	2.262 (1.438-3.558)	< 0.001
Other infections	1.2 (0.82-1.9)	0.32

γ-GGT: Gamma-glutamyl transpeptidase; AFP: Alpha fetal protein; ALB: Albumin; ALT: Alanine aminotransferase; AMMON: Ammonia; AST: Aspartate aminotransferase; AUGIB: Acute upper gastrointestinal bleeding; AUGIH: Acute upper gastrointestinal hemorrhage; BMI: Body mass index; BUN: Blood urea nitrogen; CI: Confidence interval; CTP: Child-Turcotte-Pugh; DM: Diabetic mellitus; FBG: Fasting blood glucose; HB: Hemoglobin; HE: Hepatic encephalopathy; HR: Hazard ratio; HRS: Hepatorenal syndrome; INR: International normalized ratio; Na⁺: Natriumion; K⁺: Kalium; MELD: Model for End-Stage Liver Disease; MELD-Na: Model for End-Stage Liver Disease with serum sodium; PLT: Platelet count; PT: Prothrombin time; RBC: Red blood cell; SBP: Spontaneous peritonitis; Scr: Serum creatinine; TBIL: Total bilirubin; TCHO: Total cholesterol; TG: Triglyceride; WBC: White blood cell.