In their recent study, Dr. Cammà and colleagues1 concluded that in patients with Child A cirrhosis because of hepatitis C virus, two simple, easy-to-get tests, namely the platelet/spleen ratio and insulin resistance as measured by the homeostasis model assessment of insulin resistance, regardless of the presence of diabetes, significantly predict the presence of esophageal varices, outweighing the contribution given by transient elastography. However, there is an uncertainty in interpreting the results of this study. Although the reported multivariable logistic analyses reveal two significant predictors of varices, the authors' interpretation of their results does not take into account the whole predictive models; the interpretation is mainly based on the predictive value of insulin resistance.2 In addition, this study was a cross-sectional study but not a longitudinal follow-up study and was limited by the variability and severity of the liver disease. Therefore, the further study needs to be performed that was to evaluate, in a homogeneous population of patients with cirrhosis and portal hypertension, the usefulness of insulin resistance and changes in insulin resistance over time in predicting not only the presence of varices but also the development of varices and in correlating them to changes in hepatic venous pressure gradient over time.3
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To the Editor:
Xing-Xiang Wang M.D.*, Ze-Zhou Song M.S., * Department of Cardiovascular Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China, Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.