Insulin Sensitivity / Insulin Resistance as Predictors of Esophageal Varices in Post Chronic Hepatitis C Virus Patients

Abstract

Background: Screening of Esophageal Varices (EV) in liver cirrhosis is highly recommended in all consensus reports. The standard screening procedure is endoscopy. Insulin resistance (IR) and the quantitative insulin sensitivity check index (QUICKI) are reliable predictors of portal hypertension. Objective: The study aimed to assess and compare the validity of insulin sensitivity/insulin resistance markers and other non-invasive markers for the detection of EVs in post chronic hepatitis C virus cirrhotic patients. Patients and Methods: In this cross-sectional study, 76 patients were screened by esophagogastroduodenoscopy and abdominal ultrasonography. Estimation of fasting serum insulin by ELISA technique was carried out. Homeostasis model assessment of insulin resistance (HOMA-IR) and QUICKI was performed. Results: The patients with an advanced grade of EV had higher insulin resistance and lower QUICKI. A cut-off value of HOMA-IR ≥ 3.4 could significantly predict EVs with 72% sensitivity and 80.0% specificity. Spleen diameter and platelet count/spleen diameter ratio (PC/SD) showed a significant difference among groups. Conclusion: Lower insulin sensitivity (assessed by QUICKI) and higher insulin resistance (assessed by HOMA IR) were good non-invasive predictors of EVs. In addition, portal vein (PV) diameter, spleen diameter, and PC/SD were also found as predictors of EVs.