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ORIGINAL ARTICLE
Year : 2020  |  Volume : 33  |  Issue : 1  |  Page : 55-61

Insulin resistance as a noninvasive predictor of esophageal varices in hepatitis C virus cirrhotic patients


1 Department of Tropical Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Clinical Pathology, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Correspondence Address:
Heba G Abdel-Fattah
Shebin Al Kom, Menoufia 32511
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_62_19

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Objectives The aim was to evaluate sensitivity and specificity of insulin resistance (IR) as a noninvasive predictor of esophageal varices (EV) in hepatitis C virus (HCV) cirrhotic patients. Background Variceal bleeding due to portal hypertension is associated with a high probability of circulatory dysfunction and even death. However, routine endoscopy is an invasive maneuver which consumes effort, time, and money. IR was studied as an early noninvasive predictor of EV. Patients and methods Eighty cirrhotic patients were included in this prospective case–control study and 20 nondiabetic nonhepatic patients served as the control group. Patients were recruited from the Gastrointestinal Endoscopy Unit of Tropical Medicine Department, Menoufia University Hospitals from January 2017 to March 2018. IR was calculated by the homeostasis model assessment (HOMA-IR)=fasting insulin (μU/ml)×fasting glucose (mmol/l)/22.5. Results HOMA-IR showed a high statistically significant correlation with the presence and grade of EV in HCV cirrhotic patients (P < 0.001). In comparison with others noninvasive predictors, HOMA-IR gave the highest sensitivity at a cutoff value of 4.41. Next, the midclavicular liver span/albumin ratio at a cutoff value of 3.51 was followed by the portal vein diameter at a cutoff value of 13 mm. The least sensitive predictor was the platelet count/splenic bipolar diameter ratio at a cutoff value of 1414. Conclusion IR estimated by HOMA-IR can provide sensitive information for determination of the presence and grade of EV in HCV cirrhotic patients regardless of their Child–Turcotte–Pugh classification.


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