S2803 SGLT2 Inhibitor Use and Hepatic Outcomes in Diabetic Patients With Alcoholic Cirrhosis: A Real-World Comparative Study

Introduction: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are increasingly used in diabetic patients due to their cardiorenal benefits. Prior studies have shown benefits of SGLT2i in cirrhosis, particularly in MASLD-related cases, but their impact in alcoholic cirrhosis remains unexplored. This study evaluates the association between SGLT2i use and hepatic outcomes in diabetic patients with alcoholic cirrhosis using real-world data. Methods: A retrospective cohort analysis was conducted using the TriNetX Global Collaborative Network. Adult patients with alcoholic cirrhosis and type 2 diabetes who initiated SGLT2i were compared to matched patients on other antidiabetic medications excluding SGLT2i. Patients with cirrhosis from other etiologies, including MASLD, chronic viral hepatitis, autoimmune hepatitis, hemochromatosis, and Wilson’s disease, were excluded. Propensity score matching was performed based on demographics, body mass index, and comorbidities including chronic kidney disease (assessed by eGFR) and cardiovascular disease (n = 3,472 per group). The primary outcomes were transplant-free survival and a composite of hepatic decompensation events (defined as ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, variceal bleeding, or hepatorenal syndrome). Secondary outcomes included hepatocellular carcinoma (HCC) and all-cause mortality. Patients who had any of the outcomes prior to medication initiation were excluded from the analysis. Results: SGLT2i use was associated with a lower risk of hepatic decompensation events (HR 0.71, 95% CI: 0.61–0.84, P < 0.0001) and its individual components, including ascites (HR 0.64, 95% CI: 0.54–0.75), SBP (HR 0.49, 95% CI: 0.37–0.65), hepatorenal syndrome (HR 0.53, 95% CI: 0.41–0.69), and need for hemodialysis (HR 0.50, 95% CI: 0.39–0.65), P < 0.0001 for all. There was no significant difference in transplant-free survival between the groups (HR 0.90, 95% CI: 0.66–1.24, P = 0.517). HCC incidence was numerically lower in the SGLT2i group (86 vs 129, HR 0.83, 95% CI: 0.63–1.10, P = 0.1960), though not statistically significant. All-cause mortality was significantly reduced in the SGLT2i group (HR 0.45, 95% CI: 0.40–0.50, P < 0.0001). Conclusion: In diabetic patients with alcoholic cirrhosis, SGLT2i use was associated with significantly reduced incidence of hepatic decompensation events, though no significant difference was observed in transplant-free survival. These findings support the potential benefit of SGLT2i in this population.