title: Serum cystatin C level is a good prognostic marker in patients with cirrhotic ascites and normal serum creatinine levels.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  Serum CysC level is a good marker for predicting HRS and survival in patients with cirrhotic ascites and a normal Cr level.
authors.affiliation: Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Yeon Seok
authors.initials: YS
authors.lastname: Seo
authors.forename: Eun Suk
authors.initials: ES
authors.lastname: Jung
authors.forename: Hyonggin
authors.initials: H
authors.lastname: An
authors.forename: Jeong Han
authors.initials: JH
authors.lastname: Kim
authors.forename: Young Kul
authors.initials: YK
authors.lastname: Jung
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Hyung Joon
authors.initials: HJ
authors.lastname: Yim
authors.forename: Jong Eun
authors.initials: JE
authors.lastname: Yeon
authors.forename: Kwan Soo
authors.initials: KS
authors.lastname: Byun
authors.forename: Chang Duck
authors.initials: CD
authors.lastname: Kim
authors.forename: Ho Sang
authors.initials: HS
authors.lastname: Ryu
authors.forename: Soon Ho
authors.initials: SH
authors.lastname: Um
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers; D003404:Creatinine / Q000097:blood*; D055316:Cystatin C / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006530:Hepatorenal Syndrome / Q000209:etiology; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D003404:Creatinine