Insulin Sensitivity / Insulin Resistance as Predictors of Esophageal Varices in Post Chronic Hepatitis C Virus Patients

Rehab Badawi1, *, Mona Mohamed Watany2, Hala Moustafa Elsabagh3, 4, Walaa Elkhalawany1
1 Department of Tropical Medicine and Infectious Diseases, Tanta University Hospital, Faculty of Medicine, Tanta, Egypt
2 Department of Clinical Pathology, Faculty of Medicine, Tanta University Hospital, Tanta, Egypt
3 Department of Basic Medical Science, Faculty of Dentistry, Majmaah University, KSA
4 Department of Public Health and Community, Faculty of Medicine, Tanta University, Tanta, Egypt

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© 2022 Badawi et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University., El-Giash Street 31527, Tanta, Egypt; Tel: +2-01014860506; E-mail:



Screening of Esophageal Varices (EV) in liver cirrhosis is highly recommended in all consensus reports. The standard screening procedure is endoscopy. Insulin resistance (IR) and the quantitative insulin sensitivity check index (QUICKI) are reliable predictors of portal hypertension.


The study aimed to assess and compare the validity of insulin sensitivity/insulin resistance markers and other non-invasive markers for the detection of EVs in post chronic hepatitis C virus cirrhotic patients.

Patients and Methods:

In this cross-sectional study, 76 patients were screened by esophagogastroduodenoscopy and abdominal ultrasonography. Estimation of fasting serum insulin by ELISA technique was carried out. Homeostasis model assessment of insulin resistance (HOMA-IR) and QUICKI was performed.


The patients with an advanced grade of EV had higher insulin resistance and lower QUICKI. A cut-off value of HOMA-IR ≥ 3.4 could significantly predict EVs with 72% sensitivity and 80.0% specificity. Spleen diameter and platelet count/spleen diameter ratio (PC/SD) showed a significant difference among groups.


Lower insulin sensitivity (assessed by QUICKI) and higher insulin resistance (assessed by HOMA IR) were good non-invasive predictors of EVs. In addition, portal vein (PV) diameter, spleen diameter, and PC/SD were also found as predictors of EVs.

Keywords: Esophageal varices, Homeostasis Model Assessment, Quantitative insulin sensitivity check index, Insulin sensitivity, Portal hypertension, Insulin resistance.