title: Insulin resistance in patients with cirrhosis and portal hypertension.
abstract: Insulin resistance (IR) is involved in the pathogenesis of endothelial dysfunction and is also present in patients with cirrhosis. Intrahepatic endothelial dysfunction plays a major role, increasing hepatic vascular resistance and promoting portal hypertension (PH). In addition, β-adrenergic agonists and insulin share several intracellular signaling pathways. Thus IR may influence the response to β-blockers. This study aimed at evaluating the relationship between IR and hepatic hemodynamics in patients with cirrhosis and with the portal pressure response to acute β-blockade. Forty-nine patients with cirrhosis and PH were included. Hepatic and systemic hemodynamics were measured, and IR was estimated by using the updated homeostasis model assessment (HOMA)-2 index. Patients with HOMA-2 > 2.4 were considered IR. In patients with hepatic venous pressure gradient (HVPG) ≥ 10 mmHg) [clinically significant PH (CSPH)], hemodynamic measurements were performed again 20 min after intravenous propranolol. Mean HOMA-2 index was 3 ± 1.4. Fifty-seven percent of patients had IR. A weak correlation between HOMA-2 index and HVPG was observed. Eighty-six percent of patients had CSPH. HOMA-2 index was an independent predictor of CSPH. However, in patients with CSPH, the correlation between HOMA-2 index and HVPG was lost. HVPG, but not IR, predicted the presence of esophageal varices. Response to propranolol was not different between patients with or without IR. In nondiabetic patients with cirrhosis, HOMA-2 index is directly associated with the presence of CSPH and indirectly with varices, but does not allow either grading HVPG or predicting its response to propranolol.
authors.affiliation: Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Erice
authors.forename: Elba
authors.initials: E
authors.lastname: Llop
authors.forename: Annalisa
authors.initials: A
authors.lastname: Berzigotti
authors.forename: Juan G
authors.initials: JG
authors.lastname: Abraldes
authors.forename: Ignacio
authors.initials: I
authors.lastname: Conget
authors.forename: Susana
authors.initials: S
authors.lastname: Seijo
authors.forename: Enric
authors.initials: E
authors.lastname: Reverter
authors.forename: Agustin
authors.initials: A
authors.lastname: Albillos
authors.forename: Jaume
authors.initials: J
authors.lastname: Bosch
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: García-Pagán
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000503:physiopathology*; D007333:Insulin Resistance / Q000502:physiology*; D008099:Liver / Q000187:drug effects / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011433:Propranolol / Q000494:pharmacology; D012720:Severity of Illness Index
chemical_list: D011433:Propranolol