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Article Type

Original Study

Abstract

Background and aim of the work Hepatic encephalopathy (HE) is a complex frequent neuropsychiatric manifestation of chronic and acute liver disease with disturbance of psychomotor, intellectual, cognitive, behavioral, and fine motor function of varying severity. Diabetes mellitus (DM) exacerbates progression of hepatic fibrosis. Recently, a meta-analysis study concluded that type 2 DM was associated with relative 1.5-fold increased risk for clinically defined Alzheimer disease and 2.5 for vascular dementia compared with nondiabetic individuals; furthermore, one recent prospective study showed that elevated blood glucose in the absence of DM increased the risk of dementia. Given the high prevalence of DM in the liver cirrhosis population, a better understanding of the effect of DM offers significant opportunities to improve patient outcome. Aim of the work To determine the relationship between duration of DM and blood sugar level and increase risk of the occurrence of HE in patients with liver cirrhosis. Patients and methods This study was carried out on 100 patients with cirrhosis with DM admitted between July 2017 and July 2018 in Internal Medicine Department, Shebin Elkom Teaching Hospital, Menoufia, Egypt. They were categorized into two groups according to the presence or absence of HE. Group 1 included 50 cirrhotic diabetic patients with HE and group 2 included 50 cirrhotic diabetic patients without HE. All patients in the study were subjected to a thorough physical examination; laboratory investigations, including complete blood picture, liver function tests, hepatitis B virus surface antigen, hepatitis C virus antibody, renal function tests, serum ammonia level, fasting and postprandial blood sugar, and glycated hemoglobin; tests to detect the presence of autonomic neuropathy (tilt-table test and diurnal variation of blood pressure measurement); and abdominal ultrasonography. Results The present study found a significant increase in fasting and postprandial blood glucose, glycated hemoglobin, and duration of DM in group 1 versus group 2. Positive tilt-table test and positive posture hypotension were highly significant in group 1 versus group 2. Conclusion Patients with cirrhosis with long-standing and uncontrolled DM are more likely to developed HE. Autonomic neuropathy, which may complicate patients with cirrhosis with long-standing uncontrolled diabetes, may play a role in the pathogenesis of HE in these patients.

Keywords

Autonomic neuropathy, diabetes mellitus, hepatic encephalopathy, hepatitis C, liver cirrhosis

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