title: Insulin resistance is a risk factor for esophageal varices in hepatitis C virus cirrhosis.
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 (>or=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.
authors.affiliation: Cattedra & Unità Operativa di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Italy.
authors.forename: Calogero
authors.initials: C
authors.lastname: Cammà
authors.forename: Salvatore
authors.initials: S
authors.lastname: Petta
authors.forename: Vito
authors.initials: V
authors.lastname: Di Marco
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Bronte
authors.forename: Stefania
authors.initials: S
authors.lastname: Ciminnisi
authors.forename: Giusalba
authors.initials: G
authors.lastname: Licata
authors.forename: Sergio
authors.initials: S
authors.lastname: Peralta
authors.forename: Fabio
authors.initials: F
authors.lastname: Simone
authors.forename: Giulio
authors.initials: G
authors.lastname: Marchesini
authors.forename: Antonio
authors.initials: A
authors.lastname: Craxì
mesh_terms: D000368:Aged; D018450:Disease Progression; D054459:Elasticity Imaging Techniques; D016145:Endoscopy, Digestive System / Q000191:economics; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology; D007333:Insulin Resistance / Q000502:physiology*; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010976:Platelet Count; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D013154:Spleen / Q000473:pathology