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Diabetes does not increase infection risk or mortality following an infection in patients with cirrhosis and ascites
Both cirrhosis and diabetes are established risk factors for infections. However, it remains uncertain whether diabetes adds to the risk of infections in patients with cirrhosis who are already at high risk of infections, or increases the mortality following an infection. To answer these questions,...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001534/ https://www.ncbi.nlm.nih.gov/pubmed/32039377 http://dx.doi.org/10.1016/j.jhepr.2019.07.008 |
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author | Bossen, Lars Dam, Gitte A. Vilstrup, Hendrik Watson, Hugh Jepsen, Peter |
author_facet | Bossen, Lars Dam, Gitte A. Vilstrup, Hendrik Watson, Hugh Jepsen, Peter |
author_sort | Bossen, Lars |
collection | PubMed |
description | Both cirrhosis and diabetes are established risk factors for infections. However, it remains uncertain whether diabetes adds to the risk of infections in patients with cirrhosis who are already at high risk of infections, or increases the mortality following an infection. To answer these questions, we followed a cohort of trial participants with cirrhosis and ascites for 1 year to compare the incidence of infections and post-infection mortality between those with or without diabetes. METHODS: We used Cox regression to estimate the hazard ratio (HR) of any infection, adjusting for confounding by patient age, gender, MELD score, albumin, use of proton pump inhibitors and lactulose, cirrhosis aetiology, and severity of ascites. Further, we analysed the mortality after infection. RESULTS: Among 1,198 patients with cirrhosis and ascites, diabetics (n = 289, 24%) were more likely than non-diabetics (n = 909, 76%) to be old and male, to have low platelets, and to use lactulose. At inclusion, similar proportions of diabetic and non-diabetic patients were taking a quinolone antibiotic (13% vs. 12%) and they had similar median MELD scores (14 vs. 15). During the follow-up, 446 patients had an infection. Diabetes did not increase the HR of infections (adjusted HR 1.08; 95% CI 0.87–1.35). Further, diabetes did not increase the mortality following an infection (adjusted HR 0.93; 95% CI 0.64–1.35). CONCLUSIONS: In patients with cirrhosis and ascites, diabetes did not increase infection risk or mortality after infection. The immune incompetence of each disease did not appear to be additive. In clinical terms, this means that particular attention to infections is not indicated in patients with cirrhosis and diabetes. LAY SUMMARY: Cirrhosis and diabetes are chronic diseases that weaken the immune system and increase the risk of infections, but it is unknown whether their combined effects exceed the effect of cirrhosis alone. We showed that the risk of infections was the same in patients with cirrhosis, ascites and diabetes as in patients with cirrhosis and ascites alone. Thus, their combined effects do not exceed the effect of cirrhosis alone. |
format | Online Article Text |
id | pubmed-7001534 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-70015342020-02-07 Diabetes does not increase infection risk or mortality following an infection in patients with cirrhosis and ascites Bossen, Lars Dam, Gitte A. Vilstrup, Hendrik Watson, Hugh Jepsen, Peter JHEP Rep Research Article Both cirrhosis and diabetes are established risk factors for infections. However, it remains uncertain whether diabetes adds to the risk of infections in patients with cirrhosis who are already at high risk of infections, or increases the mortality following an infection. To answer these questions, we followed a cohort of trial participants with cirrhosis and ascites for 1 year to compare the incidence of infections and post-infection mortality between those with or without diabetes. METHODS: We used Cox regression to estimate the hazard ratio (HR) of any infection, adjusting for confounding by patient age, gender, MELD score, albumin, use of proton pump inhibitors and lactulose, cirrhosis aetiology, and severity of ascites. Further, we analysed the mortality after infection. RESULTS: Among 1,198 patients with cirrhosis and ascites, diabetics (n = 289, 24%) were more likely than non-diabetics (n = 909, 76%) to be old and male, to have low platelets, and to use lactulose. At inclusion, similar proportions of diabetic and non-diabetic patients were taking a quinolone antibiotic (13% vs. 12%) and they had similar median MELD scores (14 vs. 15). During the follow-up, 446 patients had an infection. Diabetes did not increase the HR of infections (adjusted HR 1.08; 95% CI 0.87–1.35). Further, diabetes did not increase the mortality following an infection (adjusted HR 0.93; 95% CI 0.64–1.35). CONCLUSIONS: In patients with cirrhosis and ascites, diabetes did not increase infection risk or mortality after infection. The immune incompetence of each disease did not appear to be additive. In clinical terms, this means that particular attention to infections is not indicated in patients with cirrhosis and diabetes. LAY SUMMARY: Cirrhosis and diabetes are chronic diseases that weaken the immune system and increase the risk of infections, but it is unknown whether their combined effects exceed the effect of cirrhosis alone. We showed that the risk of infections was the same in patients with cirrhosis, ascites and diabetes as in patients with cirrhosis and ascites alone. Thus, their combined effects do not exceed the effect of cirrhosis alone. Elsevier 2019-08-08 /pmc/articles/PMC7001534/ /pubmed/32039377 http://dx.doi.org/10.1016/j.jhepr.2019.07.008 Text en © 2019 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Research Article Bossen, Lars Dam, Gitte A. Vilstrup, Hendrik Watson, Hugh Jepsen, Peter Diabetes does not increase infection risk or mortality following an infection in patients with cirrhosis and ascites |
title | Diabetes does not increase infection risk or mortality following an infection in patients with cirrhosis and ascites |
title_full | Diabetes does not increase infection risk or mortality following an infection in patients with cirrhosis and ascites |
title_fullStr | Diabetes does not increase infection risk or mortality following an infection in patients with cirrhosis and ascites |
title_full_unstemmed | Diabetes does not increase infection risk or mortality following an infection in patients with cirrhosis and ascites |
title_short | Diabetes does not increase infection risk or mortality following an infection in patients with cirrhosis and ascites |
title_sort | diabetes does not increase infection risk or mortality following an infection in patients with cirrhosis and ascites |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001534/ https://www.ncbi.nlm.nih.gov/pubmed/32039377 http://dx.doi.org/10.1016/j.jhepr.2019.07.008 |
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