Research Article: Clinical outcomes of patients with and without diabetes mellitus after hepatectomy: A systematic review and meta-analysis

Date Published: February 9, 2017

Publisher: Public Library of Science

Author(s): Qingshan Li, Yue Wang, Tao Ma, Yi Lv, Rongqian Wu, Sheng-Nan Lu.

http://doi.org/10.1371/journal.pone.0171129

Abstract

Clinical data regarding the influence of diabetes mellitus (DM) on the outcomes of patients undergoing hepatectomy are conflicting. To determine the impact of DM on the clinical outcomes of patients undergoing hepatectomy, we systematically reviewed published studies and carried out a meta-analysis.

A systematic literature search of Pubmed, Sciencedirect, Web of Science, and Chinese Biomedical Database was conducted from their inception through February 2, 2016. The combined relative risk (RR) or hazard ratio (HR) with 95% confidence intervals (95% CI) was calculated.

A total of 16 observational studies with 15710 subjects were eligible for meta-analysis. The pooled results showed that DM significantly increased the risk of overall postoperative complications (RR 1.34; 95% CI 1.19–1.51; P<0.001), DM-associated complications (RR 1.8; 95% CI 1.29–2.53; P<0.001), liver failure (RR 2.21; 95% CI 1.3–3.76; P = 0.028) and post-operative infections (RR 1.59; 95% CI 1.01–2.5; P = 0.045). In addition, DM was also found to be significantly associated with unfavorable overall survival and disease free survival after liver resection. The pooled HR was 1.63 (95% CI 1.33–1.99; P<0.001) for overall survival and 1.55 (95% CI 1.07–2.25; P = 0.019) for disease free survival. DM is associated with poor outcomes in patients undergoing hepatectomy. DM should be taken into account cautiously in the management of patients undergoing hepatectomy. Further prospective studies are warranted to explore effective interventions to improve the poor outcomes of diabetic patients undergoing hepatectomy.

Partial Text

Diabetes mellitus (DM) is a common chronic disease that can cause widespread health problems. It is an independent risk factor of perioperative complications and mortality in cardiovascular surgeries[1–3]. However, clinical data regarding the influence of DM on the outcomes of patients undergoing hepatectomy are conflicting[4–7], with some studies showing poorer prognosis in DM patients than non-DM patients after liver resection and others showing no difference. Moreover, DM can lead to concomitant impairment in function in various organs. It remains unclear whether DM increases postoperative morbidity after corrected for possible DM-associated organ dysfunction such as cardiac complications and renal insufficiencies. Given the lack of well-powered studies in diabetic patients undergoing hepatectomy and the conflicting results of individual studies, we conducted the following meta-analysis. Our objective was to summarize and compare existing data on the impact of DM on the clinical outcomes of patients undergoing hepatectomy.

This meta-analysis was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines[8]. We followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) consensus in this meta-analysis[9].

DM is generally considered to be an independent risk factor in surgical procedures[27]. However, the prognostic value of DM in hepatectomy remained controversial. Individual studies assessing the effects of DM in patients undergoing hepatectomy had small enrollments and yielded conflicting results[4,7,13,18]. Our meta-analysis of 15 observational studies with a total of 15710 patients addresses this discrepancy by revealing a significant relationship between DM and poor outcomes of patients undergoing hepatectomy. We found sufficient evidence of an increase in the risk of adverse events including overall postoperative complications, liver failure, and infection in diabetic patients undergoing hepatectomy. In addition, DM was found to be significantly associated with unfavorable overall survival and disease free survival after liver resection. Hence, DM should be taken into account cautiously in the management of patients undergoing hepatectomy. Follow-up for such patients should include meticulous glycemic control.

 

Source:

http://doi.org/10.1371/journal.pone.0171129

 

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