Serum cystatin C level is a good prognostic marker in patients with cirrhotic ascites and normal serum creatinine levels

Yeon Seok Seo, Eun Suk Jung, Hyonggin An, Jeong Han Kim, Young Kul Jung, Ji Hoon Kim, Hyung Joon Yim, Jong Eun Yeon, Kwan Soo Byun, Chang Duck Kim, Ho Sang Ryu, Soon Ho Um
Liver International: Official Journal of the International Association for the Study of the Liver 2009, 29 (10): 1521-7

BACKGROUND/AIMS: Serum creatinine (Cr) is not a reliable marker for early detection of renal dysfunction in patients with cirrhotic ascites. Several reports have suggested that cystatin C (CysC) is more sensitive than Cr for detecting reduced renal function in these patients. This study evaluated the clinical significance of CysC in patients with cirrhotic ascites and a normal serum Cr level.

METHODS: We enrolled patients with ascites and a normal serum Cr level (<1.2 mg/dl). Liver function tests, international normalized ratio (INR) and serum Cr and CysC levels were measured on the same day for all patients. CysC levels were measured using the automated latex-enhanced immunonephelometric method. The endpoint of follow-up was the development of hepatorenal syndrome (HRS) or mortality.

RESULTS: Seventy-eight patients with cirrhotic ascites were enrolled in the study (58 men and 30 women; age, 53+/-11 years). The underlying liver diseases in these patients were chronic hepatitis B (37%), chronic hepatitis C (4%), alcoholic liver disease (53%) and others (6%). Forty-six (59%) and 32 (41%) patients were in Child-Pugh classes B and C respectively. HRS developed in 14 patients during the follow-up period (349+/-241 days), with cumulative incidences of 10.2% and 20.4% at 6 and 12 months respectively. The CysC level was the only independent predictive factor for HRS. Twenty-three patients died during the follow-up period. CysC level and INR were independent factors for predicting mortality.

CONCLUSION: Serum CysC level is a good marker for predicting HRS and survival in patients with cirrhotic ascites and a normal Cr level.

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