Insulin resistance in liver cirrhosis

Background and aim: Liver cirrhosis is one of the leading causes of mortality in our country as well as in our region. Even though deterioration of glucose metabolism and existence of insulin resistance in liver cirrhhosis has been well documented in many studies, it is still unclear how insulin resistance mechanism develops. The aim of the present study is to assess insulin resistance, cytokines and CRP levels in patients with liver cirrhosis and control subjects. In additon, we aimed to investigate the relation of insulin resistance in liver cirrhosis with such parameters as age, sex, etiology, Child-Pugh classification, spleen size, TNF-?, IL-1ß, IL-2RES, IL-6, IL-8, IL-10, CRP and Hs-CRP.Material and method: A total of 79 patients with cirrhosis of different etilogy (49 male, 30 female) were included into the study. As controls, 50 (23 male and 27 female) subjects were taken. The two groups were compared with each other in terms of glucose, insulin, C-peptid, HOMA-IR, TNF-?, IL-1ß, IL-2RES, IL-6, IL-8, IL-10, CRP and Hs-CRP levels. In the second part of our study, the liver cirrhosis group was divided into two subgroups: Patients with HOMA-IR value >2.7 as insulin resistance positive, and those with HOMA-IR value ?2.7 as insulin resistance negative. These two groups, i.e. , HOMA-IR positive and HOMA-IR negative, were compared in terms of age, sex, etiology, Child-Pugh classification, spleen size, TNF-?, IL-1ß, IL-2RES, IL-6, IL-8, IL-10, CRP and Hs-CRP levels.Results: In liver cirrhosis group, glucose, insulin, C-peptid, HOMA-IR, TNF-?, IL-2RES, IL-6, CRP and Hs-CRP levels were determined to be significantly higher than controls. Between patients with HOMA-IR positive and negative, however, statistically no significant difference was found in terms of age, sex, etiology, Child-Pugh classification, spleen size, TNF-?, IL-1ß, IL-2RES, IL-6, IL-10, CRP and Hs-CRP levels, but IL-8 level was seen to be significantly low in patient HOMA-IR positive.Conclusion: In patients with liver cirrhosis, the levels of glucose, insulin, C-peptid, HOMA-IR, TNF-?, IL-2RES, IL-6, CRP and Hs-CRP increase with respect to normal population. Determination of increased HOMA-IR level in liver cirrhosis supports the view that insulin resistance develops in liver cirrhosis as reported in related studies. In the study, it was also determined that the mechanism of insulin resistance development occurs independent of age, sex, etiology, Child-Pugh classification, spleen size, TNF-?, IL-1ß, IL-2RES, IL-6, IL-10, CRP and Hs-CRP levels. The determination of statistically lower level of IL-8 in patients with HOMA-IR positive with respect to those with HOMA-IR negative does not indicate similarity with the studies carried out earlier.Key Words: Liver Cirrhosis, insulin resistance, cytokines.