Risk factors for hypoglycemia in hepatitis B-related acute-on-chronic liver failure and its impact on clinical outcomes

Abstract

Abstract: Objective To investigate the clinical characteristics of fasting glucose levels and the incidence of hypoglycemia in patients with hepatitis B virus(HBV)-related acute-on-chronic liver failure (ACLF), and to analyze the risk factors of hypoglycemia and its association with clinical outcomes, providing valuable insights for early clinical recognition and intervention. Methods Clinical data from 308 patients with HBV-related ACLF, admitted to the Department of Infectious Diseases at the First Affiliated Hospital of Naval Medical university between January 2016 to December 2021, were retrospectively analyzed. Patients were categorized into hypoglycemic and non-hypoglycemic groups based on fasting glucose levels. Risk factors for hypoglycemia were assessed using univariate and logistic regression analyses. Results The incidence of hypoglycemia in patients with HBV-related ACLF was 33.1%. Significant differences were observed between the hypoglycemic and non-hypoglycemic groups in gender, total bilirubin, γ- gl utamyltranspeptidase, white blood cell count, neutrophil count, prothrombin time, international normalized ratio, MELD score, MELD grade, presence of type 2 diabetes and ascites (P<0.05). Logistic regression analysis identified female gender, high baseline total bilirubin, elevated white blood cell and neutrophil counts, and the presence of ascites as risk factors for hypoglycemia, while type 2 diabetes was a protective factor. The ROC curve analysis yielded an AUC of 0.7910 (P＜0.01, 95%CI: 0.7394～0.8425). Clinical outcomes included 192 cases (62.3%) in the improvement group and 116 cases (37.7%) in the transplantation and death group. Hypoglycemia was associated with poor clinical outcome (χ²=8.379, P=0.004), For every 1mmol/L decrease in blood glucose, the risk of poor prognosis increased by 19.9% (OR=1.199, 95%CI: 1.055-1.362, P=0.005). Conclusion The incidence of hypoglycemia is elevated in patients with HBV-related ACLF and is linked to increased mortality. Women and those with ascites, high baseline total bilirubin, elevated white blood cells and neutrophil counts are at greater risk. Early identifcation and management of these high-risk patients are crucial for improving outcomes.

Key words: Acute-on-chronic liver failure, Hepatitis B virus, Hypoglycemia, Risk factor, Prognosis

DONG Xu, LIAO Wei, XU Ming-xiao, GE Ling-ling, CHEN Yi, LI Cheng-zhong. Risk factors for hypoglycemia in hepatitis B-related acute-on-chronic liver failure and its impact on clinical outcomes[J]. Chinese Hepatolgy, 2024, 29(9): 1117-1122.

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