Insulin Resistance as Predictor for Esophageal Varices in Hepatitis C Virus Cirrhosis

Abstract

Background and study aim : Portal hypertension is one of the most important complications of liver cirrhosis. Endoscopic screening of all patients with liver cirrhosis would result in a large number of unnecessary additional burden to endoscopic units. This study is designed to assess insulin resistance in cirrhotic patients due to hepatitis C infection as non invasive parameter for esophageal varices. Patients and Methods :This study was conducted on 50 cirrhotic patients (Child A) post hepatitis C who attended the Hepatology Department and outpatient clinic at Shebein El Kom Teaching Hospital. All the patients were evaluated by thorough history ,clinical examination, biochemical parameters ,metabolic features, including insulin resistance by the homeostasis model assessment (HOMA), ultrasonongraphy , liver biopsy and upper gastrointestinal endoscopy to search for esophageal varices. Results : EVs (esophageal varices) were detected in 18 of 50 patients. By multivariate analysis ,the presence of EVs was independently associated with a low platelet count/spleen diameter ratio (562.75 + 99.16) , a high HOMA-IR score (5.49 + 0.754), high body mass index , low hemoglobin, low albumin, high alanine aminotransferase and high aspartate aminotransferase. Conclusion: Insulin resistance in patients with Hepatitis C virus cirrhosis (Child A) measured by HOMA-IR score significantly predicts the presence esophageal varices in this patients and can be used as non-invasive parameter for predicting esophageal varices.