ObjectiveTo investigate the causes of hypoglycemia and the features of clinical indices in patients with liver cirrhosis and diabetes mellitus. MethodsA total of 50 patients with liver cirrhosis and diabetes mellitus who were admitted to Beijing YouAn Hospital, Capital Medical University, from January 2017 to June 2019 were enrolled as subjects, among whom 25 patients with one hypoglycemic event were enrolled as experimental group and 25 patients without hypoglycemia were enrolled as control group. Hepatic and renal function, fasting blood glucose, glycosylated hemoglobin, and Child-Pugh class were evaluated for both groups, and the time period and possible causes of hypoglycemia were analyzed. The independent samples t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. ResultsCompared with the control group, the experimental group had significantly lower levels of fasting blood glucose ［6.10(3.45~8.96) mmol/L vs 8.12(6.18~12.59)mmol/L, Z=-2.687, P=0.007］, cholinesterase ［3009.00(1788.50~4439.50)U/L vs 4936.00(4051.00~6740.50)U/L, Z=-3.095, P=0.002), albumin (32.02±7.07 g/L vs 35.89±5.49 g/L, t=2.161, P=0.036), and glycosylated hemoglobin (6.97±1.64 mmol/L vs 8.04±1.78 mmol/L, t=2.047, P=0.047). Among the patients in the experimental group, 36% had Child-Pugh class B cirrhosis and 36% had Child-Pugh class C cirrhosis, and among the patients in the control group, 56% had Child-Pugh class A cirrhosis and 40% had Child-Pugh class B cirrhosis; there was a significant difference in Child-Pugh class between the two groups (χ2=8.786, P=0.012). Most of the patients with liver cirrhosis and diabetes mellitus experienced hypoglycemia in the fasting state in the morning and in the daytime, with the main causes of excessive insulin (44%) and insufficient food intake or calorie supplementation (40%), and some patients experienced fasting asymptomatic hypoglycemia (16%). ConclusionBlood glucose monitoring and management should be taken seriously for patients with liver cirrhosis and diabetes mellitus in clinical practice, in order to reduce the occurrence of hypoglycemia.

Accurate judgment of conditions and prognosis has important clinical significance in improving survival rate and optimal distribution of liver source in patients with liver failure. This article reviews the current application of prognostic markers for liver failure such as alanine aminotransferase, aspartate aminotransferase, total bilirubin, prothrombin time, prothrombin time activity, and international normalized ratio and summarizes the new markers discovered in recent years, such as inflammatory response-related markers, neutrophil gelatinase-associated lipocalin, immune response-related markers, keratin, intestinal flora, microRNAs, liver failure autoantigen and autoantibody, and hemodynamic disorder. It is pointed out that the prognosis of liver failure is affected by many factors and there is still a lack of more sensitive and effective markers and a standardized prognostic scoring system. The new markers used alone or in combination with traditional markers may help to improve the sensitivity and specificity of prognostic evaluation of liver failure.