Insulin resistance, serum leptin, and adiponectin levels and outcomes of viral hepatitis C cirrhosis.
OBJECTIVE
Mechanisms linking obesity and unfavourable outcomes in patients with viral hepatitis C (HCV) cirrhosis are not well understood. Obesity is associated with insulin resistance, increased leptin, and decreased adiponectin serum levels.


METHODS
We assessed the predictive value of those factors for the occurrence of hepatocellular carcinoma (HCC) and liver-related death or transplantation in a cohort of 248 patients (mean age 58 (12 years, BMI 25.4 ± 4.4 kg/m(2)) with compensated HCV cirrhosis and persistent infection prospectively followed and screened for HCC.


RESULTS
The mean baseline serum levels of adiponectin and leptin were 16.8 ± 15 mg/L and 16.8 ± 19 ng/ml, respectively. The mean homeostasis model assessment of insulin resistance (HOMA) index was 3.8 ± 3; median 2.9. After a median follow-up of 72 months, 61 patients developed HCC, 58 died of liver causes, and 17 were transplanted. The incidences (Kaplan Meier) of HCC were 7%, 18%, and 27% at 5 years (p=0.017) and of liver-related death or transplantation 15%, 15% and 29% (p=0.002) according to the lowest, middle and highest tertile of HOMA, respectively. In multivariate analysis, the HOMA index was associated with HCC occurrence (HR=1.10, [1.01-1.21] p=0.026) and was a strong predictor of liver-related death or transplantation (HR=1.13, [1.07-1.21] p<0.0001). Serum levels of adiponectin and leptin were not associated with the outcome.


CONCLUSIONS
In patients with compensated HCV cirrhosis, insulin resistance but not serum levels of adiponectin and leptin predicted the occurrence of HCC and of liver-related death or transplantation.
Nkontchou
Gisèle
G
Department of Hepatogastroenterology, Hôpital Jean Verdier, Bondy, France. gisele.nkontchou@jvr.aphp.fr
Bastard
Jean-Philippe
JP
Ziol
Marianne
M
Aout
Mounir
M
Cosson
Emmanuel
E
Ganne-Carrie
Nathalie
N
Grando-Lemaire
Véronique
V
Roulot
Dominique
D
Capeau
Jacqueline
J
Trinchet
Jean-Claude
JC
Vicaut
Eric
E
Beaugrand
Michel
M
D052242:Adiponectin / Q000097:blood*; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D007333:Insulin Resistance; D020738:Leptin / Q000097:blood*; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications / Q000378:metabolism* / Q000473:pathology; D008113:Liver Neoplasms / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
D052242:Adiponectin; D020738:Leptin