Predicting esophageal varices in cirrhotic hepatitis C virus patients using noninvasive measurement of insulin resistance variables.

Background& Aims: Esophageal varices (EV) are a major complication of portal hypertension in cirrhotic patients. Screening is essential for all patients with cirrhosis. Performing non-invasive methods for screening is a cost-effective and time-saving measure. The aim of this work is to evaluate whether insulin resistance (IR) assessed by HOMA-IR score can predict the presence of EV or not.

METHODS: This cross-sectional study was carried out on sixty Egyptian cirrhotic HCV patients divided into 3 groups: Group I: 20 cirrhotic patients without esophageal varices, Group II: 20 cirrhotic patients, with small esophageal varices and Group III: 20 cirrhotic patients with large esophageal varices. Fasting insulin level was measured and HOMA- IR score was calculated. Abdominal ultrasound and Fibroscan were done to all patients.

RESULTS: Insulin resistance assessed by HOMA -IR score showed a statistically significant difference among the three groups (P<0.001) with cutoff value equal to or more than 3.40. It could significantly predict EV (AUROC= 0.841) with high sensitivity 75 %, and excellent specificity 80%. Liver stiffness measurement (LSM) with a cutoff value 40.95 kPa could significantly predict EV (AUROC= 0.629) with sensitivity 75 %, specificity 50 %.

CONCLUSION: HOMA-IR score is a new independent predictor of the presence of EV.