Insulin resistance, serum leptin, and adiponectin levels and outcomes of viral hepatitis C cirrhosis

Background 82 Aims: Mechanisms linking obesity and unfavourable outcomes in patients with viral hepatitis C (HCV) cirrhosis are not well understood. Obesity is associated with insulin resistance, increased leptin, and decreased adiponectin serum levels. Methods: We assessed the predictive value of those factors for the occurrence of hepatocellular carcinoma (HCC) and liver-related death or transplantation in a cohort of 248 patients (mean age 58 (12 years, BMI 25.4 +/- 4.4 kg/m(2)) with compensated HCV cirrhosis and persistent infection prospectively followed and screened for HCC. Results: The mean baseline serum levels of adiponectin and leptin were 16.8 +/- 15 mg/L and,16.8 +/- 19 ng/ml, respectively. The mean homeostasis model assessment of insulin resistance (HOMA) index was 3.8 +/- 3: median 2.9. After a median followup of 72 months, 61 patients developed HCC, 58 died of liver causes, and 17 were transplanted. The incidences (Kaplan Meier) of HCC were 7%, 18%, and 27% at 5 years (p = 0.017) and of liver-related death or transplantation 15%, 15% and 29% (p = 0.002) according to the lowest, middle and highest tertile of HOMA, respectively. In multivariate analysis, the HOMA index was associated with HCC occurrence (HR = 1.10, [1.01-1.21] p = 0.026) and was a strong predictor of liver-related death or transplantation (HR = 1.13, [1.07-1.21] p <0.0001). Serum levels of adiponectin and leptin were not associated with the outcome. Conclusions: In patients with compensated HCV cirrhosis, insulin resistance but not serum levels of adiponectin and leptin predicted the occurrence of HCC and of liver-related death or transplantation. (C) 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.