Influence of type 2 diabetes mellitus and fasting insulin level on the risk of spontaneous peritonitis in patients with cirrhotic ascites

Xue WU; Yilian ZHANG; Ping LI; Yuqiang MI

doi:10.3969/j.issn.1001-5256.2022.07.017

Volume 38 Issue 7

Jul. 2022

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Article Navigation > Journal of Clinical Hepatology > 2022 > 38(7): 1548-1553

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Influence of type 2 diabetes mellitus and fasting insulin level on the risk of spontaneous peritonitis in patients with cirrhotic ascites

DOI: 10.3969/j.issn.1001-5256.2022.07.017

Xue WU¹,
Yilian ZHANG²,
Ping LI^{3
,
,
,},
Yuqiang MI³

1.
Clinical College of The Second People's Hospital, Tianjin Medical University, Tianjin 300070, China
2.
Department of Infectious Diseases, Baoding First Central Hospital, Baoding, Hebei 071000, China
3.
Tianjin Second People's Hospital, Tianjin Institute of Liver Disease, Tianjin 300110, China

Research funding:

Wang Bao'en Liver Fibrosis Research Fund of China Hepatitis Prevention foundation (2021038)

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Corresponding author: LI Ping, tjlplxg@163.com (ORCID: 0000-0001-9930-6429)
Received Date: 2021-11-09
Accepted Date: 2022-01-29
Published Date: 2022-07-20

Abstract

Abstract

Objective To investigate the predictive factors for spontaneous bacterial peritonitis (SBP) in patients with decompensated cirrhotic ascites and the influence of type 2 diabetes mellitus (T2DM) and fasting insulin level on the risk of SBP. Methods A retrospective analysis was performed for the clinical data of patients who were diagnosed with liver cirrhosis and ascites in Tianjin Second People's Hospital from January 2013 to October 2018, and the patients were followed up for 1 year to record the onset time of SBP and the ending time of follow-up. Related data were obtained by searching the patients' medical records. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test or the Wilcoxon test was used for comparison of categorical data between two groups; a Cox regression analysis was used to investigate the factors for SBP in patients with cirrhotic ascites. The Kaplan-Meier method was used to plot survival curves, the log-rank test was used for survival difference analysis, and the receiver operating characteristic (ROC) curve was used to calculate the optimal cut-off value of fasting insulin. Results A total of 268 patients with cirrhotic ascites were enrolled, among whom 98 (36.6%) developed SBP. T2DM at baseline (hazard ratio [HR]=2.848, 95% confidence interval [CI]: 1.470-4.195, P < 0.05), baseline total bilirubin (TBil) (HR=1.004, 95%CI: 1.001-1.007, P < 0.05), and baseline percentage of neutrophils (N%) (HR=1.032, 95%CI: 1.010-1.055, P < 0.05) were independent predictive factors for SBP within 1 year. The Kaplan-Meier survival curve analysis showed that the patients with T2DM had a significantly higher 1-year cumulative incidence rate of SBP than those without T2DM (χ²=16.821, P < 0.05). Of all 268 patients, 88 (32.8%) had T2DM, and baseline fasting insulin ≥20.49 μU/mL (HR=2.757, 95%CI: 1.499-5.071, P < 0.05) significantly increased the risk of SBP. The Kaplan-Meier survival curve analysis showed that the fasting insulin ≥20.49 μU/mL group had a significantly higher risk of SBP within 1 year than the < 20.49 μU/mL group (χ²=13.297, P < 0.05). Conclusion The onset of SBP should be considered when patients with cirrhotic ascites have unexplained increases in TBil and N% or have T2DM or fasting insulin ≥20.49 μU/mL, and intervention measures can be adopted when necessary to delay disease progression and improve prognosis.
- Liver Cirrhosis,
- Ascites,
- Spontaneous Bacterial Peritonitis,
- Diabetes Mellitus, Type 2,
- Insulin

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References

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Influence of type 2 diabetes mellitus and fasting insulin level on the risk of spontaneous peritonitis in patients with cirrhotic ascites

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