Diabetes, hepatocellular carcinoma, and mortality in hepatitis C-infected patients: A population-based cohort study.

Background and AimThe effect of diabetes mellitus (DM) on the development of hepatocellular carcinoma (HCC) and all-cause mortality after HCC development in chronic hepatitis C virus (HCV)-infected patients remains inconclusive. This cohort study aimed to investigate these issues using the Taiwanese National Health Insurance Research Database. MethodsWe retrieved and enrolled newly diagnosed DM patients with HCV from the Longitudinal Cohort of Diabetes Patients database. Propensity score matchingincluding age, sex, alcohol-related liver disease, and baseline liver cirrhosiswas used to identify and enroll HCV patients without DM from the Longitudinal Health Insurance Database (n=1686). A multi-state model was used to investigate transitions from start-to-HCC, start-to-death, and HCC-to-death. ResultsThe multi-state model showed higher cumulative hazards for start-to-HCC, start-to-death, and HCC-to-death transitions in the DM (vs non-DM) cohort. The cumulative probability of death with or without HCC after 10years of follow-up was higher in the DM cohort than in the non-DM cohort. Multivariable transition-specific Cox models demonstrated that DM significantly increased the risk for transition from start-to-HCC (adjusted hazard ratio [aHR] 1.36; 95% confidence interval [CI] 1.16-1.59; P<0.001), start-to-death (aHR 2.61; 95% CI: 2.05-3.33; P<0.001), and HCC-to-death (aHR 1.36; 95% CI 1.10-1.68; P=0.005). The effect of liver cirrhosis on start-to-HCC and start-to-death transitions decreased over time, particularly within 2years. ConclusionsDiabetes mellitus increased the risk of HCC development in HCV-infected patients and the risk of all-cause mortality in patients with or without HCC.