S2565 The Association of Diabetes and Mortality in Hospitalizations With Hepatocellular Carcinoma: A Population-Based Cohort Study

Introduction: There is an increasing prevalence of patients with hepatocellular carcinoma (HCC) and concurrent diabetes mellitus (DM). The aim of this study was to investigate the association between a diagnosis of diabetes mellitus and in-hospital mortality in patients with hepatocellular carcinoma. Methods: A population-based cohort study of adults admitted to acute care hospitals in Texas during 2016 through 2023 with a diagnosis of HCC was completed using the Texas Inpatient Public Use Data File. The study population was identified using International Classifications of Diseases, Tenth Revisions, Clinical Modification (International Classification of Diseases, Tenth Revision code C220. The exposure was a diagnosis of DM identified using Clinical Classification Software Refined categories END004: Diabetes mellitus, Type 1 and END005: Diabetes mellitus, Type 2. The primary outcome was in-hospital mortality. Overlap propensity score weighting was the primary analysis approach. Results are reported as adjusted risk-ratio and 95% confidence interval (aRR [95% CI]). Sensitivity analyses included hospitalizations aged ≥65 years, intensive care unit admissions, and hospitalizations with a diagnosis of cirrhosis. Results: A total of 40,130 hospitalizations were identified of which 16,325(40.7%) had DM. Compared to hospitalizations without DM, hospitalizations with DM were older (57.9% vs 43.7% aged ≥65 years), more often were diagnosed with nonalcoholic steatohepatitis (14.3% vs 4.5%), and more frequently had congestive heart failure (16.9% vs 10.5%). In-hospital mortality was substantially lower in hospitalizations with DM (6.2% vs 10.0%). On adjusted analysis, DM remained negatively associated with in-hospital mortality. Similar results were observed on sensitivity analysis and for the secondary outcome of short-term mortality. Conclusion: Our study showed that patients with HCC and DM were older and had comorbidities such as nonalcoholic steatohepatitis and congestive heart failure. However, they had lower in-hospital and short-term mortality compared to patients without DM. This may reflect differences in care provided during hospitalization. Further research is needed to understand protective factors associated with DM in context of in-hospital mortality.