| Purpose: There are more and more cirrhosis of ascites patients with type 2 diabetes mellitus(T2DM),but there are few studies on the effect of type 2 diabetes mellitus and fasting insulin levels on the risk of spontaneous bacterial peritonitis(SBP)in patients with cirrhosis and ascites.The study intends to discuss the predictive factors of SBP in patients with decompensated cirrhosis and ascites,and the impact of T2 DM on the risk and outcome of SBP in patients.Importantly,this study will analyze the potential valuethe of fasting insulin level in patients with decompensated cirrhosis and ascites of further stratification of SBP and death risk.Method: A total of 268 patients with clinical diagnosis of cirrhosis and ascites admitted to the Second People’s Hospital of Tianjin from January 2013 to October 2018 were collected.The basic clinical data were retrospectively analyzed and followed up for 1 year,record the time of occurrence of SBP or the time of termination of follow-up,the data acquisition method is to query the patient’s hospitalized medical records.(1)All enrolled patients were divided into SBP group and non-SBP group.All baseline factors were included in univariate and multivariate COX regression analysis.The differences between the two groups were observed to determine the independent predictors of SBP in patients with cirrhotic ascites.(2)Divide all enrolled patients into T2 DM group and non-T2 DM group,all baseline factors were included in univariate and multivariate COX regression analysis,and Kaplan-Meier survival curve analysis was performed to compare the cumulative incidence of SBP between the two groups of patients within 1 year,clearly associating T2 DM with the risk of SBP in patients with cirrhosis and ascites.In addition,all patients in the T2 DM group were divided into SBP group and non-SBP group,and all baseline factors were included in univariate and multivariate COX regression analysis to clarify the independent predictors of SBP in patients with cirrhosis and ascites complicated with T2 DM.(3)Determine the optimal cut-off value for predicting the occurrence of SBP on fasting insulin by ROC curve,divide all patients with T2 DM into two groups with the cut-off value as the limit,and also perform single-factor and multi-factor COX regression analysis and Kaplan-Meier survival curve analysis for comparison the cumulative incidence of SBP in the two groups of patients within 1 year,analyze the relationship between insulin levels and the risk of SBP in patients with cirrhosis and ascites.SPSS 21.0 statistical software was used for statistical analysis of the data.P < 0.05 was considered statistically significant.Result: A total of 268 patients with cirrhosis and ascites were included,of which 98(36.6%)patients developed SBP,170 patients(63.4%)did not develop SBP,combined with T2 DM and total bilirubin(TBIL)and neutrophil percentage levels(N%)at baselineis were independent predictors of the occurrence of SBP within 1 year(the difference is statistically significant P < 0.05).88 patients(32.8%)had T2 DM and 180 patients(67.2%)had no T2 DM.Compared with the group without T2 DM,the prevalence of SBP and fasting blood glucose and PMN levels in the T2 DM group were significantly higher.The best cut-off value for predicting the occurrence of SBP at baseline with fasting insulin level is 20.49 u U / ml.Patients with cirrhotic ascites combined with T2 DM and baseline fasting insulin ≥ 20.49 u U / ml can significantly increase the risk of developing SBP.However,it had no significant effect on the prognosis and mortality of patients with cirrhotic ascites.Conclusion: Patients with liver cirrhosis and ascites should be alert to the occurrence of SBP when the baseline TBIL and N% levels are high.Cirrhotic ascites combined with T2 DM can increase the risk of developing SBP,and the baseline fasting insulin level can further stratify the risk of developing SBP,which can help to clarify whether further interventions are required to delay the progression of the disease,prevent the occurrence of complications,and improve prognosis. |
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