60 - Association of Sodium Glucose Co-Transporter-2 Inhibitors and Serious Liver Events in Patients With Cirrhosis on Diuretics: A Global Cohort Study

Mohamad-Noor Abu-Hammour, MD¹, Aravinthan Vignarajah, MD², Nishanthi Vigneswaramoorthy, MD³, Dian Chiang, MD^4
1Cleveland Clinic Fairview, Cleveland, OH; ²Cleveland Clinic Foundation, Cleveland, OH; ³SUNY Upstate Medical University, Syracuse, NY; ⁴Digestive Disease Institute, Cleveland Clinic, Moreland Hills, OH

Introduction: Sodium glucose co-transporter-2 inhibitors (SGLT2i) are antihyperglycemic agents acting on the SGLT-2 proteins expressed in the proximal convoluted tubules. SGLT2i has been shown to provide significant cardiovascular and renal protection effects in patients with type 2 DM and heart failure. The effect and safety of SGLT2i among patients with cirrhosis is unclear. We hypothesized that SGLT2i is associated with a reduced risk of hyponatremia and hospitalization in cirrhotic patients. Our study aims to evaluate the association between the use of SGLT2i and serious liver events in cirrhotic patients receiving diuretics in a large global database.

Methods: We identified two cohorts using the TriNetX health research database. The study cohort included 4,932 cirrhotic patients prescribed spironolactone, furosemide, and SGLT2i inhibitors. The control cohort consisted of 101,790 cirrhotic patients on spironolactone and furosemide only. Propensity score matching adjusted for key characteristics resulted in 4,931 matched pairs. The primary composite outcome included ascites, varices, hyponatremia, and all-cause mortality. Secondary outcomes included all-cause hospitalizations, hypoglycemia, and hepatorenal syndrome (HRS).

Results: The composite outcome analysis showed that the SGLT2i were associated with a significantly lower incidence of serious liver events with a hazard ratio (HR) of 0.657 (95% CI 0.630-0.685). Specific outcomes associated with improvement in the SGLT2i group: hyponatremia (HR 0.635, 95% CI 0.604-0.668), ascites (HR 0.552, 95% CI 0.519-0.587), variceal bleeding (HR 0.779, 95% CI 0.725-0.837), HRS (HR 0.411, 95% CI 0.347-0.487), all-cause hospitalization rates (HR 0.662, 95% CI 0.627-0.700), and all-cause mortality (HR 0.430, 95% CI 0.398-0.465). Moreover, the SGLT2i group were associated with a decreased incidence of hypoglycemia (HR 0.757, 95% CI 0.632-0.906).

Discussion: SGLT2i was associated with a significantly reduced risk of all-cause mortality, hospitalization rates, hyponatremia, and serious liver events in patients with cirrhosis receiving spironolactone and furosemide. These findings suggest a potential therapeutic role of SGLT2i in cirrhosis management. Prospective trials are needed to confirm these associated benefits and ensure the safety and efficacy of SGLT2i in this population.



Disclosures:


Mohamad-Noor Abu-Hammour, MD¹, Aravinthan Vignarajah, MD², Nishanthi Vigneswaramoorthy, MD³, Dian Chiang, MD⁴, 60, Association of Sodium Glucose Co-Transporter-2 Inhibitors and Serious Liver Events in Patients With Cirrhosis on Diuretics: A Global Cohort Study, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.