medigraphic.com
Órgano Oficial de la Asociación Mexicana de Hepatología

2013, Number 4

<< Back Next >>

Ann Hepatol 2013; 12 (4)

Predicting portal hypertension and variceal bleeding using non-invasive measurements of metabolic variables

Eslam M, Ampuero J, Jover M, Abd-Elhalim H, Rincon D, Shatat M, Camacho I, Kamal A, Lo Iacono O, Nasr Z, Grande L, Banares R, Khattab MA, Romero-Gomez M

Language: English
References: 26
Page: 420-430
PDF size: 162.37 Kb.


ABSTRACT

Background & aim. This study assessed the involvement of metabolic factors (anthropometric indices, insulin resistance (IR) and adipocytokines) in the prediction of portal hypertension, esophageal varices and risk of variceal bleeding in cirrhotic patients. Material and methods. Two prospective and retrospective cohorts of cirrhotic patients were selected (n = 357). The first prospective cohort (n = 280) enrolled consecutively in three centers, underwent upper gastrointestinal endoscopy, seeking evidence of esophageal varices. Clinical, anthropometric, liver function tests, ultrasonographic, and metabolic features were recorded at the time of endoscopy, patients were followed-up every 6 months until death, liver transplantation or variceal bleeding. The second retrospective cohort (n = 48 patients) had measurements of the hepatic venous pressure gradient (HVPG). Statistical analyses of the data were with the SPSS package. Results. The presence of esophageal varices was independently associated with lower platelet count, raised HOMA index and adiponectin levels. This relationship extended to subset analysis in patients with Child A cirrhosis. HOMA index and adiponectin levels significantly correlated with HVPG. Beside Child-Pugh class, variceal size and glucagonemia, HOMA index but not adiponectin and leptin plasma levels were associated with higher risk of variceal bleeding. Conclusion. In patients with cirrhosis, HOMA score correlates with HVPG and independently predict clinical outcomes. Three simple markers i.e. platelet count, IR assessed by HOMA-IR and adiponectin significantly predict the presence of esophageal varices in cirrhotic patients.


REFERENCES

  1. Schiedermmaier P. Splanchnic hemodynamics: cirrhotic versus non cirrhotic portal hypertension. J Gastroenterol Hepatol 2004; 19: S150-S154.

  2. De Franchis R. Evolving consensus in portal hypertension. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2005; 43: 167-76.

  3. de Franchis R. Non-invasive (and minimally invasive) diagnosis of oesophageal varices. J Hepatol 2008; 49: 520-7.

  4. Berzigotti A, Garcia-Tsao G, Bosch J, Grace ND, Burroughs AK, Morillas R, Escorsell A, et al for the Portal Hypertension Collaborative Group. Obesity is an independent risk factor for clinical decompensation in patients with cirrhosis. Hepatology 2011; 54: 555-61.

  5. D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol 2006; 44: 217-31.

  6. Badman MK, Flier JS. The adipocyte as an active participant in energy balance and metabolism. Gastroenterology 2007; 132: 2103-15.

  7. Finucane FM, Luan J, Wareham NJ, Sharp SJ, O’Rahilly S, Balkau B, Flyvbjerg A, et al for European Group for the Study of Insulin Resistance: Relationship between Insulin Sensitivity and Cardiovascular Disease Risk Study Group. Correlation of the leptin:adiponectin ratio with measures of insulin resistance in non-diabetic individuals. Diabetologia 2009; 52: 2345-9.

  8. Groszmann RJ, Garcia-Tsao G, Bosch J, Grace ND, Burroughs AK, Grace ND, Burroughs AK, et al. Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med 2005; 353: 2254-61.

  9. de Franchis R, Pascal JP, Ancona E, Burroughs AK, Henderson M, Fleig W, Groszmann R, et al. Definitions, methodology and therapeutic strategies in portal hypertension. A Consensus Development Workshop, Baveno, Lake Maggiore, Italy, April 5 and 6, 1990. J Hepatol 1992; 15: 256-261.

  10. Cammŕ C, Petta S, Di Marco V, Bronte F, Ciminnisi S, Licata G, Peralta S, et al. Insulin resistance is a risk factor for esophageal varices in hepatitis C virus cirrhosis. Hepatology 2008; 49: 195-203.

  11. Erdem G, Dogru T, Tasci I, Bozoglu E, Muhsiroglu O, Tapan S, Ercin CN, et al. The effects of pioglitazone and metformin on plasma visfatin levels in patients with treatment naive type 2 diabetes mellitus. Diabetes Res Clin Pract 2008; 82: 214-8.

  12. Nkontchou G, Bastard JP, Ziol M, Aout M, Cosson E, Ganne- Carrie N, Grando-Lemaire V, et al. Insulin resistance, serum leptin, and adiponectin levels and outcomes of viral hepatitis C cirrhosis. J Hepatol 2010; 53: 827-33.

  13. Chao LT, Wu CF, Sung FY, Lin CL, Liu CJ, Huang CJ, Tsai KS, et al. Insulin, glucose, and hepatocellular carcinoma risk in male hepatitis B carriers: results from 17-year follow-up of a population-based cohort. Carcinogenesis 2011; 32: 876-81.

  14. de Franchis R, Primignani M. Natural history of portal hypertension in patients with cirrhosis. Clin Liver Dis 2001; 5: 645-63.

  15. Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W; and the Pratice Guidelines Committee of the American Association for the Study of Liver Diseases, the Practice Parameters Committee of the American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007; 46: 922-38.

  16. Zaman A, Hapke RJ, Flora K, Rosen HR, Benner KG. Changing compliance to the American College of Gastroenterology guidelines for the management of variceal hemorrhage: a regional survey. Am J Gastroenterol 2004; 99: 645-9.

  17. Sud A, Hui JM, Farrell GC, Bandara P, Kench JG, Fung C, Lin R, et al. Improved prediction of fibrosis in chronic hepatitis C using measures of insulin resistance in a probability index. Hepatology 2004; 39: 1239-47.

  18. Iwakiri Y, Groszmann RJ. Vascular endothelial dysfunction in cirrhosis. J Hepatol 2007; 46: 927-34.

  19. Ratziu V, Munteanu M, Charlotte F, Bonyhay L, Poynard T; LIDO Study Group. Fibrogenic impact of high serum glucose in chronic hepatitis C. J Hepatol 2003; 39: 1049-55.

  20. Rockey DC. Hepatic fibrosis, stellate cells, and portal hypertension. Clin Liver Dis 2006; 10: 459-79.

  21. Balmer ML, Joneli J, Schoepfer A, Stickel F, Thormann W, Dufour JF. Significance of serum adiponectin levels in patients with chronic liver disease. Clin Sci 2010; 119: 431-6.

  22. Khattab M, Shatat MS, Eslam M, Mayada A, Hussein A, Gaber S, Harrison SA. Association of Serum Adipocytokines with Liver Injury in Patients with Chronic Hepatitis C Genotype 4. J Hepatol 2011; 54: S458-S459A.

  23. Tietge UJ, Böker KH, Manns MP, Bahr MJ. Elevated circulating adiponectin levels in liver cirrhosis are associated with reduced liver function and altered hepatic hemodynamics. Am J Physiol Endocrinol Metab 2004; 287: E82-E89.

  24. Sohara N, Takagi H, Kakizaki S, Sato K, Mori M. Elevated plasma adiponectin concentrations in patients with liver cirrhosis correlate with plasma insulin levels. Liver Int 2005; 25: 28-32.

  25. Kaser S, Moschen A, Kaser A, Ludwiczek O, Ebenbichler CF, Vogel W, Jaschke W, et al. Circulating adiponectin reflects severity of liver disease but not insulin sensitivity in liver cirrhosis. J Intern Med 2005; 258: 274-80.

  26. Ding X, Saxena NK, Lin S, Xu A, Srinivasan S, Anania FA. The roles of leptin and adiponectin. A novel paradigm in adipocytokines regulation of liver fibrosis and stellate cell biology. Am J Pathol 2005, 166: 1655-69.




2020     |     www.medigraphic.com