Insulin resistance as a non-invasive method for the assessment of fibrosis in patients with hepatitis C: a comparative study of biochemical methods.
BACKGROUND
Insulin resistance (IR) promotes the progression of fibrosis and diminishes response to treatment in patients with hepatitis C. Recently, Sydney's index (includes IR) has been proposed as a non-invasive method for the prediction of fibrosis.


OBJECTIVE
To assess the usefulness of Sydney's index for the prediction of advanced fibrosis (F3-F4) or absence of significant fibrosis (F0-F1) in patients with chronic hepatitis C.


METHODS
We included 131 patients suffering from chronic hepatitis C. Mean age was 40 +/- 11, 78 men and 53 women. Fibrosis stage was (F0-F1) 69 patients, F2: 40, and advanced (F3-F4) in 22 patients. We measured baseline AST, ALT, GGT, platelet, cholesterol, alcohol, and IR (HOMA - IR) levels. Sydney, Forns' and APRI indexes were calculated.


RESULTS
The area under the curve for the diagnosis of absence of significant fibrosis in each method was: Sydney: 0.80, Forns: 0.71, APRI: 0.70; p = ns. Moreover, the diagnostic capacity of advanced fibrosis was: Sydney: 0.88, Forns: 0.83, APRI: 0.82; p = ns. The predictive negative value of significant fibrosis was 74, 72, and 67%, respectively. Due to the presence of intermediate values, the indexes were not applicable to 36, 44 and 43% of patients respectively.


CONCLUSIONS
The incorporation of insulin resistance among biochemical non-invasive methods slightly improves the yield of other indexes. Nevertheless, results are suboptimal, and more than one third of patients might not be correctly classified.
Romera
M
M
Unit for Clinical Management of Digestive Diseases, Hospital Universitario de Valme, Seville, Spain.
Corpas
R
R
Romero Gómez
M
M
D000328:Adult; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D007333:Insulin Resistance; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology* / Q000378:metabolism; D008297:Male