Evidence mapPaperPMID 41137971Full record

Observational studyHepatology international2026

Diabetes mellitus is linked to higher mortality in alcohol-related acute-on-chronic liver failure.

Ashish Kumar, Anil Arora, Praveen Sharma, Rakhi Maiwall, Ashok Choudhury, Vinod Arora, Mohamed Rela, Dinesh Jothimani, Mamun A Mahtab, Harshad Devarbhavi and 90 more

Abstract readObservational Study
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Observational study in Hepatology international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Article
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  5. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

100 authors.

Ashish KumarSir Ganga Ram Hospital, New Delhi, India.
Anil AroraSir Ganga Ram Hospital, New Delhi, India.
Praveen SharmaSir Ganga Ram Hospital, New Delhi, India.
Rakhi MaiwallDepartment of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
Ashok ChoudhuryDepartment of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
Vinod AroraDepartment of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
Mohamed RelaDr. Rela Institute and Medical Centre, Chennai, India.
Dinesh JothimaniDr. Rela Institute and Medical Centre, Chennai, India.
Mamun A MahtabBangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
Harshad DevarbhaviSt. John's Medical College Hospital, Bangalore, India.
Chundamannil E EapenChristian Medical College, Vellore, India.
Ashish GoelChristian Medical College, Vellore, India.
Cesar YaghiSaint Joseph University, Beirut, Lebanon.
Qin NingTongji Hospital, Tongji Medical College/Beijing Friendship Hospital, Capital University, Beijing, China.
Tao ChenTongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Jidong JiaTongji Hospital, Tongji Medical College/Beijing Friendship Hospital, Capital University, Beijing, China.
Duan ZhongpingHepatology Institute Capital Medical University, Beijing, China.
Saeed S HamidAga Khan University Hospital, Karachi, Pakistan.
Amna S ButtAga Khan University Hospital, Karachi, Pakistan.
Wasim JafriAga Khan University Hospital, Karachi, Pakistan.
Akash ShuklaLokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, (LTMMC), Mumbai, India.
Seok S TanHospital Selayang, Bata Caves, Selangor, Malaysia.
Dong J KimInstitute for Liver and Digestive Diseases, College of Medicine, Hallym University, Chuncheon, 24252, Republic of Korea.
Anoop SarayaDepartment of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
Jinhua HuThe Fifth Medical Centre of Chinese, PLA General Hospital, Beijing, China.
Ajit SoodDayanand Medical College, Ludhiana, India.
Omesh GoyalDayanand Medical College, Ludhiana, India.
Vandana MidhaDayanand Medical College, Ludhiana, India.
Manoj SahuMS and SUM Hospital, K8 Kalinga Nagar, Shampur, Bhubaneswar, Odisha, India.
Guan H LeeNational University Health System, Singapore, Singapore.
Sombat TreeprasertsukChulalongkorn University, Bangkok, Thailand.
Kessarin ThanapiromChulalongkorn University, Bangkok, Thailand.
Ameet MandotGlobal Hospital, Mumbai, India.
Samir ShahDepartment of Hepatology and Liver Intensive Care, Global Hospitals, Mumbai, India.
Ravikiran MaghadeGlobal Hospital, Mumbai, India.
Laurentius A LesmanaDigestive Disease and Oncology Centre, Medistra Hospital, Jakarta, Indonesia.
Rinaldi C LesmanaCipto Mangunkusumo Hospital, Medical Faculty University of Indonesia, Jakarta, Indonesia.
Hasmik GhazinyanNork Clinical Hospital of Infectious Disease Armenia, Yerevan, Armenia.
Virukalpatti G Mohan PrasadVGM Gastro Hospital, Coimbatore, India.
Abdul K DokmeciAnkara University School of Medicine, Ankara, Turkey.
Jose D SollanoCardinal Santos Medical Center, Metro Manila, Philippines.
Zaigham AbbasDr. Ziauddin University Hospital, Clifton, Karachi, Pakistan.
Ananta ShresthaAlka Hospital, Sitapaila Height, Kathmandu, Nepal.
George K LauHumanity and Health Medical Centre, Hong Kong SAR, China.
Diana A PayawalFatima Medical University Hospital, Valenzuela Metro Manila, Philippines.
Gamal E ShihaEgyptian Liver Research Institute and Hospital (ELRIAH), Sherbin, Egypt.
Ajay DusejaDepartment of Hepatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Sunil TanejaDepartment of Hepatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Nipun VermaDepartment of Hepatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Padaki N RaoDepartment of Hepatology, AIG Hospitals, Hyderabad, India.
Anand V KulkarniDepartment of Hepatology, AIG Hospitals, Hyderabad, India.
Mithun SharmaDepartment of Hepatology, AIG Hospitals, Hyderabad, India.
Fazal KarimSir Salimullah Medical College, Mitford Hospital, Dhaka, Bangladesh.
Radha K DhimanSanjay Gandhi Post Graduate Institute (SGPGI), Uttar Pradesh, Lucknow, India.
Ajay K MishraSanjay Gandhi Post Graduate Institute (SGPGI), Uttar Pradesh, Lucknow, India.
Shahinul AlamBangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
Osamu YokosukaGraduate School of Medicine, Chiba University, Chuo-Ku, Chiba, Japan.
Debashis ChowdhuryChattagram Maa O Shishu Hospital, Chittagong, Bangladesh.
Vivek A SaraswatMahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India.
Chandan K KedarisettyGleneagles Global Hospitals, Hyderabad, India.
Sanjiv SaigalMax Super Speciallity Hospital, Saket, New Delhi, India.
Ghulam N YattooThumbay Hospital, Fujairah, UAE.
Abraham KoshyVPS Lakeshore Hospital, Kochi, India.
Ajay K PatwaDepartment of Medicine, King George's Medical University, Lucknow, India.
Mohamed ElbasionyMansoura University, Mansoura, Egypt.
Pravin M RathiTN Medical College and BYL Nair Hospital, Mumbai, India.
Sudhir MaharshiSMS Medical College & Hospitals, Jaipur, India.
Vishwa M DayalIndira Gandhi Institute of Medical Sciences, Patna, India.
Ashish K JhaIndira Gandhi Institute of Medical Sciences, Patna, India.
Kemal F KalistaDr. Cipto Mangunkusumo National General Hospital, Medical Faculty Universitas Indonesia, Jakarta, Indonesia.
Rino A GaniDr. Cipto Mangunkusumo National General Hospital, Medical Faculty Universitas Indonesia, Jakarta, Indonesia.
Man F YuenQueen Mary Hospital, Hong Kong SAR, China.
Virendra SinghPunjab Institute of Liver and Biliary Sciences, Mohali, Punjab, India.
Ayaskanta SinghSUM Ultimate Medicare, Bhubaneswar, India.
Violeta A SargsyanVioleta Medical Centre, Yerevan, Armenia.
Chien H HuangLinkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan.
Saurabh S MukewarMidas Multispeciality Hospital Pvt. Ltd, Nagpur, Maharashtra, India.
Shaojie XinLiver Failure Treatment and Research Center, The Fifth Medical Center of Chinese, PLA General Hospital, Beijing, China.
Ruveena B RajaramDepartment of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Charles PanackelAster Medcity, Ernakulam, Kerala, India.
Sunil DadhichS. N. Medical College, Jodhpur, Rajasthan, India.
Sanjeev SachdevaG.B. Pant Hospital, New Delhi, India.
Ajay KumarG.B. Pant Hospital, New Delhi, India.
Sanatan BeheraSCB Medical College and Hospital, Cuttack, Odisha, India.
Prabir MajiDepartment of Gastroenterology IMS & SUM Hospital II, Bhubaneswar, India.
Lubna KamaniLiaquat National Hospital, Karachi, Sindh, Pakistan.
Hemamala V SaithanyamurthiMIOT International Hospital, Chennai, Tamil Nadu, India.
Joy VargheseGleneagles Global Health City, Chennai, India.
Pathik ParikhZydus Hospital, Ahmedabad, India.
P JavedAster MIMS Hospital, Kannur, India.
Neeraj SarafMedanta, The Medicity Multispeciality Hospital, Gurgaon, India.
Narendra S ChoudharyMedanta, The Medicity Multispeciality Hospital, Gurgaon, India.
Akash RoyApollo Multispeciality Hospital, Kolkata, India.
Mahesh GoenkaApollo Multispeciality Hospital, Kolkata, India.
Chetan KalalNanavati Max Super Speciality Hospital, Mumbai, India.
Krishnadas DevadasGovernment Medical College, Trivandrum, India.
Gupse AdaliIstanbul Umraniye Training and Research Hospital, Istanbul, Turkey.
Hithanadura J de SilvaDepartment of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, 11010, Sri Lanka.
Shiv K SarinDepartment of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India. shivsarin@gmail.com.ORCID http://orcid.org/0000-0002-0544-5610
APASL ACLF Research Consortium (AARC) for APASL ACLF working Party

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAcute-on-chronic liver failure (ACLF) is a rapidly progressive syndrome marked by high short-term mortality. While diabetes mellitus (DM) is known to worsen liver-related outcomes, its specific impact on alcohol-related ACLF (ALD-ACLF) remains underexplored. This study aimed to assess the prognostic impact of DM on 90-day outcomes in ALD-ACLF using data from the APASL ACLF Research Consortium (AARC) database.

methodsThis observational study involved data from 5612 ACLF patients with documented 90-day outcomes. We identified 2096 patients with ALD-ACLF precipitated by alcoholic hepatitis. Patients with non-ALD etiologies, mixed etiologies, or non-alcoholic precipitants were excluded. Diabetic and non-diabetic patients were compared using 1:2 propensity score matching based on key baseline covariates. Survival outcomes were assessed using Kaplan-Meier analysis and multivariable Cox regression.

resultsAfter matching, 109 diabetic patients were compared with 218 well-matched non-diabetic controls. Diabetic patients had significantly lower overall survival (32 vs. 57%) and transplant-free survival (31 vs. 50%) compared to non-diabetics (log-rank p < 0.001). On multivariable Cox regression, DM was independently associated with increased 90-day mortality (HR 1.739, 95% CI 1.262-2.395, p < 0.001), along with elevated serum lactate (HR 1.187 per mmol/L, p < 0.001) and creatinine (HR 1.267 per mg/dL, p < 0.001).

conclusionDiabetes mellitus is a significant independent predictor of mortality in patients with ALD-ACLF. These findings highlight the need for early identification and integrated management of diabetes in ACLF care pathways to improve clinical outcomes.

Indexed as

Acute-On-Chronic Liver FailureDiabetes ComplicationsDiabetes MellitusHepatitis, AlcoholicAgedFemaleHumansKaplan-Meier EstimateMaleMiddle AgedPrognosisPropensity ScoreAcute-on-chronic liver failure (ACLF)Alcoholic hepatitisAlcoholic liver diseaseALD-ACLFDiabetes mellitus

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.