الفهرس 
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Abstract
The aim of the present study is to evaluate sensitivity and specificity of insulin resistance as non-invasive parameter in the prediction of EV in patients with HCV induced cirrhosis.
This study was carried out on 100 non-diabetic patients subdivided into 80 patients with HCV induced cirrhosis and 20 healthy subjects without evidence of any liver disease as controls. Patients and controls were classified into the following groups:
• group I: 80 patients diagnosed HCV induced cirrhosis by clinical criteria based on (history, physical examination, laboratory and imaging findings) who were subdivided into:
group IA: 20 patients with liver cirrhosis and grade I EV by endoscopy.
group IB: 20 patients with liver cirrhosis and grade II EV by endoscopy.
group IC: 20 patients with liver cirrhosis and grade III EV by endoscopy.
group ID: 20 patients with liver cirrhosis and grade IV EV by endoscopy.
• group II: 20 patients with no evidence of liver disease or portal hypertension, neither endoscopic or laboratory, as controls.
For this purpose, all patients were subjected to:
A. Thorough history taking.
B. Full general and local examination.
C. Laboratory investigations: including
1. Complete blood picture.
2. Renal function tests (blood urea and serum creatinine).
3. Liver function tests serum alanine transaminase (ALT), serum aspartate transaminase (AST), serum billirubin (Total and direct),s. albumin, prothrombin concentration.
4. Serological tests for viral markers (HBsAg, HCV Ab) by (ELISA).
5. Fasting plasma glucose concentration.
6. Fasting insulin (ìU/ml) immunoenzymetric assay: Calculation of insulin resistance by homeostasis model assessment (HOMA-IR) = fasting insulin (μU/ml) × fasting glucose (m mol/L) / 22.5
D. pelviabdominal ultrasound was done for all participants to show the features of liver cirrhosis, measure portal vein diameter, measure bipolar diameter of spleen and detect perisplenic collaterals.
E. Patients were subjected to esophagogastroduodenoscopy (EGD) within maximum 2 weeks of investigation of laboratory parameters.
Results were collected, tabulated, statistically analyzed by IBM personal computer and statistical package SPSS version 11.
Statistical analysis of the presenting data revealed:
There is statistically-insignificant difference between the studied groups as regards age, sex, BMI or fasting blood glucose level.
There is statistically-significant difference between the studied groups regarding ascites, jaundice, previous history of variceal bleeding, and previous episodes of hepatic encephalopathy (P-value < 0.05).
There was a high statistically-significant difference between the studied groups regarding fasting blood insulin levels (p-value<0.001).
HOMA-IR index (p-value<0.001).
There was statistically-insignificant correlation between HOMA-IR with age or sex of studied patients while there was a statistically-significant correlation between HOMA-IR and each of fasting insulin level, WBCs ,platelet, INR, bilirubin ,albumin, portal v. diameter ,splenic bipolar diameter ,mid clavicular liver span ,platlet /spleen diameter ratio and Mid clavicular liver span/Albumin ratio (p value <0.001).
The best cut off value of HOMA-IR in group IA was >2.1 with a diagnostic sensitivity of 85%, a specificity of 65%, a positive predictive value of 70.8%, and a negative predictive value of 81.2% and accuracy was 75.6%.
Correlation of HOMA-IR levels between group II and group IB showed that at a cut-off level >4.41, the sensitivity was 90%, specificity 90%, PPV 90%, NPV 90% and accuracy was 95.3%.
Correlation of HOMA-IR levels between group II and each of grade III O.V and grade IV O.V patients revealed that at a cut-off level >5.9, the sensitivity was 100%,specificity 100%,PPV 100%,NPV 100% and accuracy100% .
On comparison between HOMA-IR, Platelet count/Spleen diameter ratio, mid clavicular liver span /Albumin concentration ratio and portal vein diameter as 4 non-invasive parameters that can provide accurate information pertinent to determination of the presence and grade of esophageal varices in patients with HCV induced cirrhosis:
- HOMA-IR score gave the highest accuracy (92.7%) at a cut-off value of 4.4 with (sensitivity 80% and specificity 90%).
- The next highest accuracy was the mid clavicular liver span /albumin ratio (86.3%) at a cut-off value of 3.5 with (sensitivity 79.5% and specificity 85%)
- Portal vein diameter (86.1%) at a cut-off value of 13 mm with (sensitivity 77.5% and specificity 85%).
- The least accurate of the 4 non-invasive predictors was platelet count/spleen diameter ratio (79.1%) at a cut-off of 1414 with (sensitivity 78.7% and specificity 80%).