ABSTRACT
Background: Liver is the major site for carbohydrate, protein and lipid metabolism. In liver cirrhosis, derangements in metabolic functions can happen. Liver cirrhosis can lead to insulin resistance then impaired glucose tolerance and finally diabetes. The occurrence of insulin resistance in cirrhosis has definite clinical implications like rapid progression to fibrosis and increased risk of gastrointestinal haemorrhage and hepatocellular carcinoma. Objectives: This study was done to find the prevalence of insulin resistance in patients with cirrhosis in Government Royapettah Hospital due to varied etiology. Materials and methods: It was a cross sectional study done on 50 subjects in Government Royapettah Hospital. Patients were selected according to the inclusion criteria. A detailed history was taken, and a thorough clinical examination was done followed by further investigations, all of which were recorded in a pre-designed, structured proforma. Insulin resistance was assessed using three indices: HOMA1 IR, HOMA2 IR calculator and TyG index. Results: The mean age of the population was 46.18± 9.78 years. 94% of patients were males and 6% were females. Among the fifty subjects included, 34% had insulin resistance according to HOMA 1 IR (p 0.024) and 28% with HOMA2 IR (p 0.002). Insulin resistance using both HOMA 1 and 2 was significantly increased in Child Turcott Pugh C (p <0.001 for both). Insulin resistance was not demonstrated in any of subjects using TyG index. There was positive correlation between insulin resistance and fasting glucose and insulin. S Kalaichelvi, Kiruthika Somasundram. Prevalence of insulin resistance among patients with cirrhosis of liver in Government Royapettah Hospital, Chennai. IAIM, 2016; 3(7): 21-27. Page 22 Conclusion: Insulin resistance is demonstrated in liver cirrhosis which is increased with advancing disease. It can be concluded that regular monitoring of glycemic status is mandatory in these patients who would have definite bearing upon treatment strategy.
ABSTRACT
Background: Child Turcotte Pugh (CTP) score and Model for End Stage Liver Disease (MELD) are used commonly to assess the prognosis of liver disease but the disadvantage of these static tests is their inability to identify the functional reserve of the liver. Among all quantitative liver function tests indocyanine green (ICG) clearance test is most widely used and has been used to determine operative risk before hepatectomy and to assess prognosis of patients with cirrhosis. Aim: To correlate indocyanine green (ICG) clearance test with MELD score in patients with cirrhosis of liver. Methods: Forty patients with cirrhosis of liver were included and divided into two groups according to their CTP scores. Group A had 20 patients with CTP class A and group B had 20 patients with CTP class B. After ICG injection, ICG retention at 15 minutes (ICGR15) and ICG clearance rate were calculated. Results: In group A, the mean ICGR15 was 32.86% + 6.4% while in group B it was 51.08% + 12.8% (p <0.001). ICG clearance rates were 4.3% + 2.8% and 3.5% + 3.8% per minute in group A and B respectively. MELD score had a strong positive correlation with ICGR15 but a negative correlation with ICG clearance rate. On ROC curve analysis, AUC for MELD was 0.805 vs. 0.88 for ICGR15 in assessing prognosis of patients with cirrhosis. The sensitivity and specificity of MELD score was 60% and 80% respectively while that of ICGR15 was 85% and 90% respectively. Conclusion: ICGR15 has a higher sensitivity and specificity than MELD score in assessing the prognosis of patients with cirrhosis of liver.