Diabetes mellitus is linked to higher mortality in alcohol-related acute-on-chronic liver failure

Kumar A 1 , Arora A 1 , Sharma P 1 , Maiwall R 2 , Choudhury A 2 , Arora V 2 Show all authors , Rela M 3 , Jothimani D 3 , Mahtab MA 4 , Devarbhavi H 5 , Eapen CE 6 , Goel A 6 , Yaghi C 7 , Ning Q 8 , Chen T 9 , Jia J 8 , Zhongping D 10 , Hamid SS 11 , Butt AS 11 , Jafri W 11 , Shukla A 12 , Tan SS 13 , Kim DJ 14 , Saraya A 2 , Hu J 15 , Sood A 16 , Goyal O 16 , Midha V 16 , Sahu M 17 , Lee GH 18 , Treeprasertsuk S 19 , Thanapirom K 19 , Mandot A 20 , Shah S 21 , Maghade R 20 , Lesmana LA 22 , Lesmana RC 23 , Ghazinyan H 24 , Prasad VGM 25 , Dokmeci AK 26 , Sollano JD 27 , Abbas Z 28 , Shrestha A 29 , Lau GK 30 , Payawal DA 31 , Shiha GE 32 , Duseja A 33 , Taneja S 33 , Verma N 33 , Rao PN 34 , Kulkarni AV 34 , Sharma M 34 , Karim F 35 , Dhiman RK 36 , Mishra AK 36 , Alam S 4 , Yokosuka O 37 , Chowdhury D 38 , Saraswat VA 39 , Kedarisetty CK 40 , Saigal S 41 , Yattoo GN 42 , Koshy A 43 , Patwa AK 44 , Elbasiony M 45 , Rathi PM 46 , Maharshi S 47 , Dayal VM 48 , Jha AK 48 , Kalista KF 49 , Gani RA 49 , Yuen MF 50 , Singh V 51 , Singh A 52 , Sargsyan VA 53 , Huang CH 54 , Mukewar SS 55 , Xin S 56 , Rajaram RB 57 , Panackel C 58 , Dadhich S 59 , Sachdeva S 60 , Kumar A 60 , Behera S 61 , Maji P 62 , Kamani L 63 , Saithanyamurthi HV 64 , Varghese J 65 , Parikh P 66 , Javed P 67 , Saraf N 68 , Choudhary NS 68 , Roy A 69 , Goenka M 69 , Kalal C 70 , Devadas K 71 , Adali G 72 , de Silva HJ 73 , Sarin SK 74 , APASL ACLF Research Consortium (AARC) for APASL ACLF working Party

Affiliations 

  • 1 Sir Ganga Ram Hospital, New Delhi, India
  • 2 Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
  • 3 Dr. Rela Institute and Medical Centre, Chennai, India
  • 4 Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  • 5 St. John's Medical College Hospital, Bangalore, India
  • 6 Christian Medical College, Vellore, India
  • 7 Saint Joseph University, Beirut, Lebanon
  • 8 Tongji Hospital, Tongji Medical College/Beijing Friendship Hospital, Capital University, Beijing, China
  • 9 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
  • 10 Hepatology Institute Capital Medical University, Beijing, China
  • 11 Aga Khan University Hospital, Karachi, Pakistan
  • 12 Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, (LTMMC), Mumbai, India
  • 13 Hospital Selayang, Bata Caves, Selangor, Malaysia
  • 14 Institute for Liver and Digestive Diseases, College of Medicine, Hallym University, Chuncheon, 24252, Republic of Korea
  • 15 The Fifth Medical Centre of Chinese, PLA General Hospital, Beijing, China
  • 16 Dayanand Medical College, Ludhiana, India
  • 17 MS and SUM Hospital, K8 Kalinga Nagar, Shampur, Bhubaneswar, Odisha, India
  • 18 National University Health System, Singapore, Singapore
  • 19 Chulalongkorn University, Bangkok, Thailand
  • 20 Global Hospital, Mumbai, India
  • 21 Department of Hepatology and Liver Intensive Care, Global Hospitals, Mumbai, India
  • 22 Digestive Disease and Oncology Centre, Medistra Hospital, Jakarta, Indonesia
  • 23 Cipto Mangunkusumo Hospital, Medical Faculty University of Indonesia, Jakarta, Indonesia
  • 24 Nork Clinical Hospital of Infectious Disease Armenia, Yerevan, Armenia
  • 25 VGM Gastro Hospital, Coimbatore, India
  • 26 Ankara University School of Medicine, Ankara, Turkey
  • 27 Cardinal Santos Medical Center, Metro Manila, Philippines
  • 28 Dr. Ziauddin University Hospital, Clifton, Karachi, Pakistan
  • 29 Alka Hospital, Sitapaila Height, Kathmandu, Nepal
  • 30 Humanity and Health Medical Centre, Hong Kong SAR, China
  • 31 Fatima Medical University Hospital, Valenzuela Metro Manila, Philippines
  • 32 Egyptian Liver Research Institute and Hospital (ELRIAH), Sherbin, Egypt
  • 33 Department of Hepatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
  • 34 Department of Hepatology, AIG Hospitals, Hyderabad, India
  • 35 Sir Salimullah Medical College, Mitford Hospital, Dhaka, Bangladesh
  • 36 Sanjay Gandhi Post Graduate Institute (SGPGI), Uttar Pradesh, Lucknow, India
  • 37 Graduate School of Medicine, Chiba University, Chuo-Ku, Chiba, Japan
  • 38 Chattagram Maa O Shishu Hospital, Chittagong, Bangladesh
  • 39 Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
  • 40 Gleneagles Global Hospitals, Hyderabad, India
  • 41 Max Super Speciallity Hospital, Saket, New Delhi, India
  • 42 Thumbay Hospital, Fujairah, UAE
  • 43 VPS Lakeshore Hospital, Kochi, India
  • 44 Department of Medicine, King George's Medical University, Lucknow, India
  • 45 Mansoura University, Mansoura, Egypt
  • 46 TN Medical College and BYL Nair Hospital, Mumbai, India
  • 47 SMS Medical College & Hospitals, Jaipur, India
  • 48 Indira Gandhi Institute of Medical Sciences, Patna, India
  • 49 Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty Universitas Indonesia, Jakarta, Indonesia
  • 50 Queen Mary Hospital, Hong Kong SAR, China
  • 51 Punjab Institute of Liver and Biliary Sciences, Mohali, Punjab, India
  • 52 SUM Ultimate Medicare, Bhubaneswar, India
  • 53 Violeta Medical Centre, Yerevan, Armenia
  • 54 Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
  • 55 Midas Multispeciality Hospital Pvt. Ltd, Nagpur, Maharashtra, India
  • 56 Liver Failure Treatment and Research Center, The Fifth Medical Center of Chinese, PLA General Hospital, Beijing, China
  • 57 Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 58 Aster Medcity, Ernakulam, Kerala, India
  • 59 S. N. Medical College, Jodhpur, Rajasthan, India
  • 60 G.B. Pant Hospital, New Delhi, India
  • 61 SCB Medical College and Hospital, Cuttack, Odisha, India
  • 62 Department of Gastroenterology IMS & SUM Hospital II, Bhubaneswar, India
  • 63 Liaquat National Hospital, Karachi, Sindh, Pakistan
  • 64 MIOT International Hospital, Chennai, Tamil Nadu, India
  • 65 Gleneagles Global Health City, Chennai, India
  • 66 Zydus Hospital, Ahmedabad, India
  • 67 Aster MIMS Hospital, Kannur, India
  • 68 Medanta, The Medicity Multispeciality Hospital, Gurgaon, India
  • 69 Apollo Multispeciality Hospital, Kolkata, India
  • 70 Nanavati Max Super Speciality Hospital, Mumbai, India
  • 71 Government Medical College, Trivandrum, India
  • 72 Istanbul Umraniye Training and Research Hospital, Istanbul, Turkey
  • 73 Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, 11010, Sri Lanka
  • 74 Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India. shivsarin@gmail.com
Hepatol Int, 2026 Feb;20(1):149-162.
PMID: 41137971 DOI: 10.1007/s12072-025-10914-3

Abstract

BACKGROUND: Acute-on-chronic liver failure (ACLF) is a rapidly progressive syndrome marked by high short-term mortality. While diabetes mellitus (DM) is known to worsen liver-related outcomes, its specific impact on alcohol-related ACLF (ALD-ACLF) remains underexplored. This study aimed to assess the prognostic impact of DM on 90-day outcomes in ALD-ACLF using data from the APASL ACLF Research Consortium (AARC) database.

METHODS: This observational study involved data from 5612 ACLF patients with documented 90-day outcomes. We identified 2096 patients with ALD-ACLF precipitated by alcoholic hepatitis. Patients with non-ALD etiologies, mixed etiologies, or non-alcoholic precipitants were excluded. Diabetic and non-diabetic patients were compared using 1:2 propensity score matching based on key baseline covariates. Survival outcomes were assessed using Kaplan-Meier analysis and multivariable Cox regression.

RESULTS: After matching, 109 diabetic patients were compared with 218 well-matched non-diabetic controls. Diabetic patients had significantly lower overall survival (32 vs. 57%) and transplant-free survival (31 vs. 50%) compared to non-diabetics (log-rank p 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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