Insulin Resistance is a Risk Factor for Oesophageal Varices and Hepatic Decompensation in Patients with Hepatitis C Virus Related Liver Cirrhosis

Background: Insulin resistance (IR) is frequently associated with hepatitis C virus (HCV) infection, and development of IR can occur early in the course of HCV infection and promote hepatic fibrosis. Aim of the Study: We aimed to assess the impact of IR on the development of oesophageal varices (OV) in HCV-related liver cirrhosis. Subjects and Methods: We enrolled 80 HCV-related liver cirrhosis patients with endoscopically diagnosed OV and 30 patients without. Clinical, biochemical, ultrasonographic, and assessment of IR by the homeostasis model assessment (HOMA) were recorded. Results: A high HOMA-IR score was reported in patients with OV than in those without (4.6±0.91 vs. 2.86±0.74; p=<0.001). Moreover, there was significant increase of HOMAIR score in OV patients with Child-Pugh class C than in those with other classes. In addition, endoscopic study showed significant increase of HOMA-IR scores in patients with large sized OV and in those with risky signs, gastric varices and portal hypertensive gastropathy and also, in bleeding OV. Correlation studies showed that HOMA-IR scores had significant positive correlations with Child-Pugh scores, portal vein diameter, longitudinal diameter of spleen, serum triglyceride, serum insulin levels, histological activity index (HAI) and stages of hepatic fibrosis and significant negative correlation with platelets count. Assessment of area under curve (AUC) showed that HOMA-IR had AUC of 0.925. At cutoff value of 3.05, HOMA-IR scores had 92.5% sensitivity and 80% specificity for detection of OV. Conclusion: We concluded that HOMA-IR model could be implicated not only in the development but also in the progression of OV and susceptibility to bleeding in patients with HCV-related liver cirrhosis.