title: Clinical value of increased serum creatinine concentration as predictor of short-term outcome in decompensated cirrhosis.
abstract: BACKGROUND
  The purpose of this study was to assess whether serum creatinine concentration alone or associated with other biological parameters was an independent predictor of short-term mortality in patients with decompensated cirrhosis.
  
  
  METHODS
  A total of 212 consecutive episodes of decompensated cirrhosis in patients admitted to the hospital between January 1999 and December 2001 were reviewed retrospectively. Depending on a serum creatinine concentration equal to or greater than 1.5 mg/dL at the time of admission, patients were divided into decompensated cirrhosis with renal failure (101 episodes in 59 patients, aged 69.8 +/- 10 years) and without renal failure (111 episodes in 61 patients, aged 64.5 +/- 13 years). Outcome (alive, death) during the episode of decompensation of liver disease and outcome at 90 days after admission were assessed.
  
  
  RESULTS
  Differences in the frequency of variables according to outcome in the overall episodes of decompensated cirrhosis with and without renal failure showed significant differences between patients who died and those who were alive both at hospital discharge and at 90 days in serum bilirubin, Child-Pugh score, MELD (model for end-stage liver disease) score, and serum creatinine levels. In the multivariate analysis, serum creatinine was not an independent predictor of outcome. The prediction accuracy according to the area under the ROC (receiver operating characteristic) curve was greater for the MELD scale than for serum creatinine.
  
  
  CONCLUSIONS
  Serum creatinine concentration is a parameter that should be included in the prognostic assessment of patients with decompensated cirrhosis, but should be combined with other specific parameters of liver function, such as bilirubin, albumin, and the international normalized ratio (INR) for prothrombin time.
authors.affiliation: Service of Hepatology, Hospital Clínico Universitario, University of Valencia, ES-46010 Valencia, Spain. Miguel.A.Serra@uv.es
authors.forename: M A
authors.initials: MA
authors.lastname: Serra
authors.forename: M J
authors.initials: MJ
authors.lastname: Puchades
authors.forename: F
authors.initials: F
authors.lastname: Rodríguez
authors.forename: A
authors.initials: A
authors.lastname: Escudero
authors.forename: J A
authors.initials: JA
authors.lastname: del Olmo
authors.forename: A H
authors.initials: AH
authors.lastname: Wassel
authors.forename: J M
authors.initials: JM
authors.lastname: Rodrigo
mesh_terms: D000368:Aged; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D012372:ROC Curve; D051437:Renal Insufficiency / Q000150:complications; D012709:Serum Albumin / Q000032:analysis; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D012709:Serum Albumin; D003404:Creatinine; D001663:Bilirubin