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Increased risk of hepatocellular carcinoma among patients with hepatitis C cirrhosis and diabetes mellitus
Author(s) -
Veldt Bart J.,
Chen Wendong,
Heathcote E. Jenny,
Wedemeyer Heiner,
Reichen Juerg,
Hofmann W. Peter,
de Knegt Robert J.,
Zeuzem Stefan,
Manns Michael P.,
Hansen Bettina E.,
Schalm Solko W.,
Janssen Harry L. A.
Publication year - 2008
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.22251
Subject(s) - medicine , diabetes mellitus , interquartile range , gastroenterology , hepatocellular carcinoma , hazard ratio , cirrhosis , odds ratio , body mass index , type 2 diabetes mellitus , hepatitis c , confidence interval , endocrinology
Recent studies suggest that diabetes mellitus increases the risk of developing hepatocellular carcinoma (HCC). The aim of this study is to quantify the risk of HCC among patients with both diabetes mellitus and hepatitis C in a large cohort of patients with chronic hepatitis C and advanced fibrosis. We included 541 patients of whom 85 (16%) had diabetes mellitus. The median age at inclusion was 50 years. The prevalence of diabetes mellitus was 10.5% for patients with Ishak fibrosis score 4, 12.5% for Ishak score 5, and 19.1% for Ishak score 6. Multiple logistic regression analysis showed an increased risk of diabetes mellitus for patients with an elevated body mass index (BMI) (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.00‐1.11; P = 0.060) and a decreased risk of diabetes mellitus for patients with higher serum albumin levels (OR, 0.81; 95% CI, 0.63‐1.04; P = 0.095). During a median follow‐up of 4.0 years (interquartile range, 2.0‐6.7), 11 patients (13%) with diabetes mellitus versus 27 patients (5.9%) without diabetes mellitus developed HCC, the 5‐year occurrence of HCC being 11.4% (95% CI, 3.0‐19.8) and 5.0% (95% CI, 2.2‐7.8), respectively ( P = 0.013). Multivariate Cox regression analysis of patients with Ishak 6 cirrhosis showed that diabetes mellitus was independently associated with the development of HCC (hazard ratio, 3.28; 95% CI, 1.35‐7.97; P = 0.009). Conclusion: For patients with chronic hepatitis C and advanced cirrhosis, diabetes mellitus increases the risk of developing HCC. (H EPATOLOGY 2008;47:1856–1862.)