JAMA Netw Open

SGLT2 inhibitor use associated with lower rates of serious liver events in cirrhosis

July 3, 2025

SGLT2 inhibitors may confer significant protection against serious liver-related complications in cirrhotic patients on diuretic therapy, supporting further investigation of their role in cirrhosis management.

Study details: This large, multicenter cohort study analyzed adults with cirrhosis on furosemide and spironolactone, using data from over 120 health care organizations. Patients receiving SGLT2 inhibitors in addition to standard diuretics were propensity-matched 1:1 to controls on diuretics alone. Primary outcome was a composite of serious liver events (ascites, variceal development, hyponatremia, or all-cause mortality) over a 3-year follow-up. Secondary outcomes included variceal bleeding, paracentesis, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome, hepatocellular carcinoma, hypoglycemia, and all-cause hospitalizations.

Results: Among 10,660 matched patients (mean age 63.8 years, 57.8% male), SGLT2 inhibitor use was associated with a significantly lower incidence of serious liver events (hazard ratio [HR], 0.68; 95% confidence interval, 0.66–0.71; P < 0.001). Risks of hepatorenal syndrome (HR, 0.47), spontaneous bacterial peritonitis (HR, 0.55), paracentesis (HR, 0.54), variceal bleeding (HR, 0.79), hypoglycemia (HR, 0.75), and all-cause hospitalizations (HR, 0.67) were all reduced in the SGLT2 inhibitor group.

Source:

Abu-Hammour MN, et al. (2025, June 2). JAMA Netw Open. Sodium-Glucose Cotransporter 2 Inhibitors and Serious Liver Events in Patients With Cirrhosis. https://pubmed.ncbi.nlm.nih.gov/40577010/