Insulin resistance is a risk factor for esophageal varices in hepatitis C virus cirrhosis

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http://www3.interscience.wiley.com/journal/121422527/abstract?CRETRY=1 & SRETRY=0

Hepatology

Published Online: 26 Sep 2008

Liver Failure/Cirrhosis/Portal Hypertension

Insulin resistance is a risk factor for esophageal varices in hepatitis C virus

cirrhosis

Calogero Cammà 1, Salvatore Petta 1 *§, Vito Di Marco 1, Fabrizio Bronte 1,

Stefania Ciminnisi 1, Giusalba Licata 1, Peralta 1, Fabio Simone 1,

Giulio Marchesini 2, Craxì 1

1Cattedra & Unità Operativa di Gastroenterologia, Di.Bi.M.I.S., University of

Palermo, Italy2Dipartimento di Medicina e Gastroenterologia, Alma Mater

Studiorum, University of Bologna, Italy

email: Salvatore Petta (petsa@...

*Correspondence to Salvatore Petta, Gastroenterologia & Epatologia, Piazza delle

Cliniche, 2, 90127 Palermo, Italy

Potential conflict of interest: Nothing to report.These authors contributed

equally to the study.§fax (39) 091-655-2156

Abstract

Indirect methods to predict the presence of esophageal varices (EV) in patients

with cirrhosis are not sensitive enough to be used as a surrogate for endoscopy.

We tested the effectiveness of liver stiffness measurement (LSM) by transient

elastography and the presence of insulin resistance (IR), a marker associated

with fibrosis progression, in the noninvasive prediction of portal hypertension.

One hundred four consecutive patients with newly diagnosed Child A hepatitis C

virus (HCV) cirrhosis underwent upper gastrointestinal endoscopy to search for

EV. Clinical, anthropometric, biochemical, ultrasonographic, and metabolic

features, including IR by the homeostasis model assessment (HOMA), and LSM by

transient elastography, were recorded at the time of endoscopy. EVs were

detected in 63 of 104 patients (60%). In 10 patients (16%), the EVs were

medium-large (F2). By multivariate analysis, the presence of EVs was

independently associated with a low platelet count/spleen diameter ratio (OR,

0.998; 95% CI, 0.996-0.999) and a high HOMA-IR score (OR, 1.296; 95%CI,

1.018-1.649), not with LSM (OR, 1.009; 95%CI, 0.951-1.070). It is noteworthy

that nine of ten patients with medium-large EVs had a platelet/spleen ratio of

less than 792 or an HOMA-IR of greater than 3.5. The independent association

between low platelet count/spleen diameter ratio (OR, 0.998; 95%CI,

0.996-1.000), high HOMA-IR score (OR, 1.373; 95%CI, 1.014-1.859) and presence of

EV was confirmed in the subgroup of 77 nondiabetic subjects. Conclusions: In

patients with Child A HCV cirrhosis, two simple, easy-to-get tests, namely the

platelet/spleen ratio and insulin resistance measured by HOMA-IR, regardless of

the presence of diabetes, significantly predict the presence of EV, outweighing

the contribution given by transient elastography. (HEPATOLOGY 2008.)

Received: 5 September 2008

Digital Object Identifier (DOI)10.1002/hep.22655