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Background <p>Acute-on-chronic liver failure (ACLF) is a rapidly progressive syndrome marked by high short-term mortality. While diabetes mellitus (DM) is known to worsen liver-related outcomes, its specific impact on alcohol-related ACLF (ALD-ACLF) remains underexplored. This study aimed to assess the prognostic impact of DM on 90-day outcomes in ALD-ACLF using data from the APASL ACLF Research Consortium (AARC) database.</p> Methods <p>This observational study involved data from 5612 ACLF patients with documented 90-day outcomes. We identified 2096 patients with ALD-ACLF precipitated by alcoholic hepatitis. Patients with non-ALD etiologies, mixed etiologies, or non-alcoholic precipitants were excluded. Diabetic and non-diabetic patients were compared using 1:2 propensity score matching based on key baseline covariates. Survival outcomes were assessed using Kaplan–Meier analysis and multivariable Cox regression.</p> Results <p>After matching, 109 diabetic patients were compared with 218 well-matched non-diabetic controls. Diabetic patients had significantly lower overall survival (32 vs. 57%) and transplant-free survival (31 vs. 50%) compared to non-diabetics (log-rank p &lt; 0.001). On multivariable Cox regression, DM was independently associated with increased 90-day mortality (HR 1.739, 95% CI 1.262–2.395, p &lt; 0.001), along with elevated serum lactate (HR 1.187 per mmol/L, p &lt; 0.001) and creatinine (HR 1.267 per mg/dL, p &lt; 0.001).</p> Conclusion <p>Diabetes mellitus is a significant independent predictor of mortality in patients with ALD-ACLF. These findings highlight the need for early identification and integrated management of diabetes in ACLF care pathways to improve clinical outcomes.</p>

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Diabetes mellitus is linked to higher mortality in alcohol-related acute-on-chronic liver failure

  • 期刊论文

  • 发表日期：

    2025年10月25日

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  • Ashish Kumar,
  • Anil Arora,
  • Praveen Sharma,
  • Rakhi Maiwall,
  • Ashok Choudhury,
  • Vinod Arora,
  • Mohamed Rela,
  • Dinesh Jothimani,
  • Mamun A. Mahtab,
  • Harshad Devarbhavi,
  • Chundamannil E. Eapen,
  • Ashish Goel,
  • Cesar Yaghi,
  • Qin Ning,
  • Tao Chen,
  • Jidong Jia,
  • Duan Zhongping,
  • Saeed S. Hamid,
  • Amna S. Butt,
  • Wasim Jafri,
  • Akash Shukla,
  • Seok S. Tan,
  • Dong J. Kim,
  • Anoop Saraya,
  • Jinhua Hu,
  • Ajit Sood,
  • Omesh Goyal,
  • Vandana Midha,
  • Manoj Sahu,
  • Guan H. Lee,
  • Sombat Treeprasertsuk,
  • Kessarin Thanapirom,
  • Ameet Mandot,
  • Samir Shah,
  • Ravikiran Maghade,
  • Laurentius A. Lesmana,
  • Rinaldi C. Lesmana,
  • Hasmik Ghazinyan,
  • Virukalpatti G. Mohan Prasad,
  • Abdul K. Dokmeci,
  • Jose D. Sollano,
  • Zaigham Abbas,
  • Ananta Shrestha,
  • George K. Lau,
  • Diana A. Payawal,
  • Gamal E. Shiha,
  • Ajay Duseja,
  • Sunil Taneja,
  • Nipun Verma,
  • Padaki N. Rao,
  • Anand V. Kulkarni,
  • Mithun Sharma,
  • Fazal Karim,
  • Radha K. Dhiman,
  • Ajay K. Mishra,
  • Shahinul Alam,
  • Osamu Yokosuka,
  • Debashis Chowdhury,
  • Vivek A. Saraswat,
  • Chandan K. Kedarisetty,
  • Sanjiv Saigal,
  • Ghulam N. Yattoo,
  • Abraham Koshy,
  • Ajay K. Patwa,
  • Mohamed Elbasiony,
  • Pravin M. Rathi,
  • Sudhir Maharshi,
  • Vishwa M. Dayal,
  • Ashish K. Jha,
  • Kemal F. Kalista,
  • Rino A. Gani,
  • Man F. Yuen,
  • Virendra Singh,
  • Ayaskanta Singh,
  • Violeta A. Sargsyan,
  • Chien H. Huang,
  • Saurabh S. Mukewar,
  • Shaojie Xin,
  • Ruveena B. Rajaram,
  • Charles Panackel,
  • Sunil Dadhich,
  • Sanjeev Sachdeva,
  • Ajay Kumar,
  • Sanatan Behera,
  • Prabir Maji,
  • Lubna Kamani,
  • Hemamala V. Saithanyamurthi,
  • Joy Varghese,
  • Pathik Parikh,
  • P. Javed,
  • Neeraj Saraf,
  • Narendra S. Choudhary,
  • Akash Roy,
  • Mahesh Goenka,
  • Chetan Kalal,
  • Krishnadas Devadas,
  • Gupse Adali,
  • Hithanadura J. de Silva,
  • Shiv K. Sarin

摘要

Background

Acute-on-chronic liver failure (ACLF) is a rapidly progressive syndrome marked by high short-term mortality. While diabetes mellitus (DM) is known to worsen liver-related outcomes, its specific impact on alcohol-related ACLF (ALD-ACLF) remains underexplored. This study aimed to assess the prognostic impact of DM on 90-day outcomes in ALD-ACLF using data from the APASL ACLF Research Consortium (AARC) database.

Methods

This observational study involved data from 5612 ACLF patients with documented 90-day outcomes. We identified 2096 patients with ALD-ACLF precipitated by alcoholic hepatitis. Patients with non-ALD etiologies, mixed etiologies, or non-alcoholic precipitants were excluded. Diabetic and non-diabetic patients were compared using 1:2 propensity score matching based on key baseline covariates. Survival outcomes were assessed using Kaplan–Meier analysis and multivariable Cox regression.

Results

After matching, 109 diabetic patients were compared with 218 well-matched non-diabetic controls. Diabetic patients had significantly lower overall survival (32 vs. 57%) and transplant-free survival (31 vs. 50%) compared to non-diabetics (log-rank p < 0.001). On multivariable Cox regression, DM was independently associated with increased 90-day mortality (HR 1.739, 95% CI 1.262–2.395, p < 0.001), along with elevated serum lactate (HR 1.187 per mmol/L, p < 0.001) and creatinine (HR 1.267 per mg/dL, p < 0.001).

Conclusion

Diabetes mellitus is a significant independent predictor of mortality in patients with ALD-ACLF. These findings highlight the need for early identification and integrated management of diabetes in ACLF care pathways to improve clinical outcomes.