Diabetes mellitus demonstrated as independent predictor of cirrhosis, hepatocellular carcinoma

SAN DIEGO — Patients with diabetes- and steatohepatitis-related liver disease are more likely to develop hepatocellular carcinoma, cirrhosis and encephalopathy — and at a faster rate — than nondiabetic patients, a presenter said here.

“Diabetes is proving to be a much more important risk factor for — not just nonalcoholic steatohepatitis — but alcoholic steatohepatitis and the development of the disease process,” Evan Raff, MD, of the department of internal medicine at the University of Alabama at Birmingham, said during the American College of Gastroenterology Annual Scientific Meeting. “It’s proving to increase the likelihood of worsening of the disease from simple inflammation to fibrosis and, eventually, hepatocellular carcinoma formation.”

Evan Raff, MD

Evan Raff

Researchers analyzed 503 medical charts of patients with steatohepatitis-related liver disease for demographics, comorbidities including diabetes mellitus, cirrhosis and complications, hepatocellular carcinoma and laboratory, imaging, and histology data, Raff said.

Diabetic patients (n=206) more often presented with cirrhosis (75% vs. 64%; P=.01) and hepatocellular carcinoma (9% vs. 3%; P=.005) than nondiabetic patients (n=297), he said. They also were more likely to develop hepatic encephalopathy (31% vs. 19%; P=.003) with a trend for higher stage 3 or 4 fibrosis in 95 biopsied cases (67% vs. 49%; P=.09) than patients without diabetes. Diabetes mellitus also independently predicted the presence of cirrhosis and hepatocellular carcinoma.

“Increased screening methods may need to be imposed as a result of these finding,” Raff said. “If you know somebody has diabetes and you know they also have some form of steatohepatitis … they may require different screening modalities and surveillance guidelines for things like hepatocellular carcinoma or earlier interventions for their liver disease.”

Disclosure: Raff reports no relevant financial disclosures.

For more information:

Raff E. #1424: Diabetes Mellitus Is an Independent Predictor of Cirrhosis and Hepatocellular Carcinoma in Patients with Steatohepatitis Related Liver Disease. Presented at: the 2013 American College of Gastroenterology Annual Scientific Meeting; Oct. 11-16, San Diego.

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