Type 2 diabetes mellitus increases liver transplant-free mortality in patients with cirrhosis: A systematic review and meta-analysis

doi:10.12998/wjcc.v9.i20.5514

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World Journal of Clinical Cases

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Meta-Analysis

World J Clin Cases. Jul 16, 2021; 9(20): 5514-5525
Published online Jul 16, 2021. doi: 10.12998/wjcc.v9.i20.5514

Type 2 diabetes mellitus increases liver transplant-free mortality in patients with cirrhosis: A systematic review and meta-analysis

Zi-Jin Liu, Yi-Jie Yan, Hong-Lei Weng, Hui-Guo Ding

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).

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
Processing time: 147 Days and 22.9 Hours

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.