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World J Gastroenterol. 2013 Dec 28;19(48):9432-8. doi: 10.3748/wjg.v19.i48.9432.

Cystatin C is a biomarker for predicting acute kidney injury in patients with acute-on-chronic liver failure.

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Zhi-Hong Wan, Jian-Jun Wang, Shao-Li You, Hong-Ling Liu, Bing Zhu, Hong Zang, Chen Li, Jing Chen, Shao-Jie Xin, Liver Failure Treatment and Research Center, Beijing 302 Hospital, Beijing 100039, China.



To investigate serum cystatin C level as an early biomarker for predicting acute kidney injury (AKI) in patients with acute-on-chronic liver failure (ACLF).


Fifty-six consecutive patients with hepatitis B virus-related ACLF who had normal serum creatinine (Cr) level (< 1.2 mg/dL in men, or < 1.1 mg/dL in women) were enrolled in the Liver Failure Treatment and Research Center of Beijing 302 Hospital between August 2011 and October 2012. Thirty patients with chronic hepatitis B (CHB) and 30 healthy controls in the same study period were also included. Measurement of serum cystatin C (CysC) was performed by a particle-enhanced immunonephelometry assay using the BN Prospec nephelometer system. The ACLF patients were followed during their hospitalization period.


In the ACLF group, serum level of CysC was 1.1 ± 0.4 mg/L, which was significantly higher (P < 0.01) than those in the healthy controls (0.6 ± 0.3 mg/L) and CHB patients (0.7 ± 0.2 mg/L). During the hospitalization period, eight ACLF patients developed AKI. Logistic regression analysis indicated that CysC level was an independent risk factor for AKI development (odds ratio = 1.8; 95%CI: 1.4-2.3, P = 0.021). The cutoff value of serum CysC for prediction of AKI in ACLF patients was 1.21 mg/L. The baseline CysC-based estimated glomerular filtration rate (eGFR(CysC)) was significantly lower than the creatinine-based eGFR (eGFR(CG) and eGFR(MDRD)) in ACLF patients with AKI, suggesting that baseline eGFR(CysC) represented early renal function in ACLF patients while the Cr levels were still within the normal ranges.


Serum CysC provides early prediction of renal dysfunction in ACLF patients with a normal serum Cr level.


Acute kidney injury; Acute-on-chronic liver failure; Creatinine; Cystatin C; Prediction

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