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J Gastroenterol Hepatol. 2018 Apr;33(4):910-917. doi: 10.1111/jgh.13983. Epub 2018 Jan 26.

Serum cystatin C level: An excellent predictor of mortality in patients with cirrhotic ascites.

Author information

1
Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
2
Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
3
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
4
Department of Internal Medicine, Soonchunhyang University College of Medicine, Asan, Korea.
5
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
6
Department of Internal Medicine, Keimyung University College of Medicine, Daegu, Korea.
7
Department of Internal Medicine, Inje University College of Medicine, Pusan, Korea.
8
Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.
9
Department of Internal Medicine, Cheju Halla General Hospital, Jeju, Korea.
10
Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
11
Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Korea.
12
Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND AND AIM:

Although serum cystatin C level is considered a more accurate marker of renal function in patients with liver cirrhosis, its prognostic efficacy remains uncertain. This study aimed to evaluate the prognostic efficacy of serum cystatin C level in patients with cirrhotic ascites.

METHODS:

Patients with cirrhotic ascites from 15 hospitals were prospectively enrolled between September 2009 and March 2013. Cox regression analyses were performed to identify independent predictive factors of mortality and development of type 1 hepatorenal syndrome (HRS-1).

RESULTS:

In total, 350 patients were enrolled in this study. The mean age was 55.4 ± 10.8 years, and 267 patients (76.3%) were men. The leading cause of liver cirrhosis was alcoholic liver disease (64.3%), followed by chronic viral hepatitis (29.7%). Serum creatinine and cystatin C levels were 0.9 ± 0.4 mg/dL and 1.1 ± 0.5 mg/L, respectively. Multivariate analyses revealed that international normalized ratio and serum bilirubin, sodium, and cystatin C levels were independent predictors of mortality and international normalized ratio and serum sodium and cystatin C levels were independent predictors of the development of HRS-1. Serum creatinine level was not significantly associated with mortality and development of HRS-1 on multivariate analysis.

CONCLUSION:

Serum cystatin C level was an independent predictor of mortality and development of HRS-1 in patients with cirrhotic ascites, while serum creatinine level was not. Predictive models based on serum cystatin C level instead of serum creatinine level would be more helpful in the assessment of the condition and prognosis of patients with cirrhotic ascites.

KEYWORDS:

creatinine; cystatin C; hepatorenal syndrome; liver cirrhosis; renal dysfunction

PMID:
28910501
DOI:
10.1111/jgh.13983
[Indexed for MEDLINE]

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