Insulin/high-density lipoprotein cholesterol ratio: A newlydiscovered predictor of esophageal varices in patients with hepatitis C virus-related cirrhosis in the absence of diabetes mellitus

Özet

Background/Aims: Insulin resistance (IR) is closely linked with chronic hepatitis C virus (HCV) and its complications, particularly hepaticfibrosis. The aim of the present study was to investigate some biochemical markers that are potentially related to IR as predictors ofesophageal varices (EV) in patients with compensated HCV cirrhosis who do not have diabetes or metabolic syndrome.Materials and Methods: One hundred subjects without diabetes with compensated HCV-related cirrhosis who did not fulfill the diagnostic criteria of metabolic syndrome were subjected to clinical, laboratory, ultrasonographic, and endoscopic assessments.Results: EV were evident in 73 patients with lower platelet counts and high-density lipoprotein cholesterol (HDL-C) levels. On the contrary, the fasting values of both insulin and glucose, the homeostatic model assessment for insulin resistance (HOMA-IR) score, and thebipolar diameter of the spleen of patients with EV were higher than those of other patients who were varices-free. Multivariate analysisconfirmed insulin/HDL-C ratio (P=0.01) and HOMA-IR score (P=0.039) as predictors for the presence of varices. The best cut-off valuesabove which the risk of the latter occurrence increased were 0.147 (sensitivity 89%) and 2.24 (sensitivity 72.6%) for both predictors,respectively.Conclusion: The present study recorded two valid predictors of HCV-related EV: HOMA-IR score and insulin/HDL-C ratio. The latter ismore sensitive and is likely more convenient in the case of individuals without diabetes. The validity of two IR-related predictors in theabsence of metabolic syndrome confirmed the suggestion that the mechanism of IR-related HCV is different from that of the traditionalmetabolic syndrome.