Protective Effect of Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i) on Liver Function: Results From MELD Analysis in Surgical Revascularization-A Preliminary Study.
Urbanowicz T, Bajsert M, et al. • Medical science monitor : international medical journal of experimental and clinical research • 2026
Long-term preoperative SGLT2i therapy was associated with distinct perioperative MELD dynamics in OPCAB, with relative preservation of bilirubin and INR despite creatinine changes, suggesting potential modulation of hepatic function during perioperative stress.
Key Findings
Results
On postoperative day 1, patients receiving long-term preoperative SGLT2i therapy exhibited significantly lower bilirubin levels compared to the control group.
Between-group comparison was statistically significant at P < 0.001
Study population: 111 consecutive patients undergoing elective OPCAB in 2024
SGLT2i group: n = 26 (long-term preoperative therapy ≥3 months); control group: n = 85
Chronic hepatic or renal disease patients were excluded
By postoperative day 6, differences in bilirubin between groups had attenuated
Results
On postoperative day 1, the SGLT2i group had significantly lower INR compared to the non-SGLT2i group.
Between-group difference in INR was statistically significant at P = 0.04
INR was assessed preoperatively and on postoperative days 1 and 6
Baseline INR was comparable between groups
Within-group analysis showed significant time effects for INR in both groups with large effect sizes (Kendall's W = 0.48–0.88)
Results
On postoperative day 1, the SGLT2i group had a significantly lower overall MELD score compared to controls.
Between-group difference in MELD score on postoperative day 1 was P = 0.03
Baseline MELD scores were comparable between the two groups
By postoperative day 6, differences in MELD score had attenuated
Within-group analysis showed significant time effects for MELD in both groups
Results
On postoperative day 1, the SGLT2i group had significantly higher creatinine levels compared to the control group.
Between-group difference in creatinine on postoperative day 1 was P = 0.002
Creatinine was assessed preoperatively and on postoperative days 1 and 6
Within-group analysis showed significant time effects for creatinine in both groups
The higher creatinine in the SGLT2i group contrasted with the relatively preserved hepatic markers (bilirubin and INR)
Results
Total bilirubin changed significantly over time in the control group but not in the SGLT2i group.
Within-group time-effect analysis used the Friedman test with Bonferroni post hoc testing
Large effect sizes were observed across groups (Kendall's W = 0.48–0.88)
This differential pattern of bilirubin change suggests potential hepatic protection associated with SGLT2i use
Authors describe this as suggesting 'potential modulation of hepatic function during perioperative stress'
Discussion
The study was a retrospective, preliminary, single-center analysis with a relatively small SGLT2i group, limiting the generalizability of findings.
SGLT2i group consisted of only 26 patients versus 85 in the control group
Retrospective observational design introduces possible confounding
Authors describe results as 'hypothesis-generating' and note they 'warrant prospective confirmation'
All patients underwent elective OPCAB in 2024 at a single center
SGLT2i therapy was defined as ≥3 months of preoperative use
What This Means
This research suggests that patients who were taking a class of diabetes medications called SGLT2 inhibitors (such as empagliflozin or dapagliflozin) for at least three months before heart bypass surgery showed signs of better liver protection during the early postoperative period compared to patients not on these drugs. Specifically, on the first day after surgery, SGLT2i users had lower levels of bilirubin and a clotting measure called INR—both of which are markers of liver stress—as well as a lower overall liver risk score (MELD score). Interestingly, their kidney marker (creatinine) was higher, suggesting the drugs may have different effects on the liver versus kidneys during surgical recovery.
The study enrolled 111 patients who underwent a type of heart bypass surgery called off-pump coronary artery bypass grafting (OPCAB) in 2024. Researchers compared 26 patients on long-term SGLT2i therapy to 85 patients not on these medications. Importantly, patients with pre-existing liver or kidney disease were excluded, and the two groups had similar baseline scores before surgery. By the sixth day after surgery, most differences between the groups had diminished, suggesting the protective effect may be most pronounced in the immediate postoperative period.
This research suggests that SGLT2 inhibitors—already known to protect the heart and kidneys—may also offer some degree of liver protection during the physiological stress of cardiac surgery. However, because this was a small, retrospective (looking back at records) study, the authors themselves caution that the findings are preliminary and hypothesis-generating. Larger, prospective clinical trials are needed to confirm whether these drugs truly protect liver function during surgery and to better understand the underlying mechanisms.
Urbanowicz T, Bajsert M, Kowalczyk M, Marcinkowska Z, Wiśniewska O, Krasińska-Płachta A, et al.. (2026). Protective Effect of Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i) on Liver Function: Results From MELD Analysis in Surgical Revascularization-A Preliminary Study.. Medical science monitor : international medical journal of experimental and clinical research. https://doi.org/10.12659/MSM.953130