Comparison of HOMA-IR, Tg/Glucose Index and Tg/HDL-C ratio for predicating MetSy in HCV seronegative heroin dependents

Background: Мetabolic syndrome (MetSy) with insulin resistance was presented in heroin dependents as well as in general population. Recent studies showed that methadone substitution presented a worse metabolic profile compared to buprenorphine's. The study aims to compare the predictive power of surogat markers such as Triglyceride-Glucose (TgG) index, HOMA-IR and Triglyceride/HDL-C (Tg/HDL-C) ratio for easier detecting MetSy in heroin dependents.

Methods: the study was cross sectional, including 160 heroin dependents. Triglyceride-glucose index (TgG) was calculated by TgG calculator ( www.optimaldx.com), HOMA-IR was calculated by homeostasis model assessment of insulin resistance (Fasting Insulin x Fasting Glucose) /22.5. MetSy was diagnosed by harmonized IDF criteria.

Results: The heroin dependents were predominantly males (88,1% / 11,9%), aged 28,19  ±  5,85 years with BMI 21,56  ± 1,83 kg/m2  and dependence duration 5,06  ±  4,3 years. The transaminases were not increased more then double the referent range: AST ±26.6 13.1U/l and ALT 27.5 ±22.7 U/l and the patients were seronegative  for HCV and HBV infection.  The IDF criteria detected 9. 3%  while harmonized IDF criteria detected 11.2% of them with MetSy. The lowest and insignificant predictive value was registered  for HOMA-IR model [AUROC(HOMAIR)= 0.648,  95%CI 0.497 to 0.779, P=0.072], intermediate and significant prediction for TgG index model [AUROC(TgG)=0.773, 95%CI 0.631 to 0.916, P<0.001]  and highest and significant predication was presented for Tg/HDL-C ratio model [AUROC(Tg/HDL -C)= 0.846, 95%CI 0.727 to 0.964, P<0.001], with cut off value for Tg/HDL-C > 1.58, sensitivity 93.7%( 95%CI 69.8 - 99.8), specificity 73.77% (%CI 65.0 - 81.3).

Conclusions: Tg/HDL- C ratio can be used as useful surrogate marker for predicting MetSy in heroin dependents. The quick and easy detection of MetS in heroin dependents is important not only as a metabolic and cardiovascular risk factor, but also as an indicator for recommending a favorable substitution program.

Key words: heroin, dependence, opioids, metabolic syndrome, insulin resistance, triglyceride-glucose index, triglyceride/HDL-C ratio

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