Hypoglycemia on admission in patients with acute on chronic liver failure: a retrospective cohort analyzing the current situation, risk factors, and associations with prognosis

Background: Hypoglycemia is a common phenomenon in patients with various severe liver diseases. However, its implications for the prognosis of patients with acute on chronic liver failure remains largely unknown. This study investigated the status of hypoglycemia in patients with acute on chronic liver failure, as well as its risk factors and correlation with 90-day patient outcomes.Methods: A total of 218 patients with acute on chronic liver failure diagnosed and treated in our hospital from January 2019 to August 2021 were enrolled. Hypoglycemia is defined as a fasting blood glucose level <= 2.8 mmol/L. Baseline data on the patients' clinical characteristics and laboratory examinations were collected. Patients were followed-up with a primary outcome of 90-day mortality. The risk factors for hypoglycemia were identified by univariate and multivariate logistic regression.Results: A total of 99 cases (45.41%) had hypoglycemia. Liver cirrhosis [odds ratio (OR) =5.16, P<0.001] and a higher model for end-stage liver disease (MELD) score (OR =1.29, P<0.001) were risk factors for hypoglycemia in acute on chronic liver failure, while higher fibrinogen (FIB) was a protective factor for hypoglycemia (OR =0.17, P=0.001). The 90-day mortality rate in the hypoglycemia group was significantly higher than that in the non-hypoglycemia group (72.73% vs. 48.74%, P<0.001). After adjusting for hepatic encephalopathy, cirrhosis, and MELD scores, hypoglycemia (OR =8.72, P=0.01) was still an independent risk factor for 90-day mortality in patients with acute on chronic liver failure.Conclusions: Hypoglycemia is common in patients with acute on chronic liver failure and is related to poor prognosis. Patients with cirrhosis, a higher MELD score, and a significant decrease in FIB are more likely to develop hypoglycemia. Thus whether ameliorating hypoglycemia could improve patient outcomes deserves additional investigations.