Serum cystatin C level is a good prognostic marker in patients with cirrhotic ascites and normal serum creatinine levels.
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.
Seo
Yeon Seok
YS
Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Jung
Eun Suk
ES
An
Hyonggin
H
Kim
Jeong Han
JH
Jung
Young Kul
YK
Kim
Ji Hoon
JH
Yim
Hyung Joon
HJ
Yeon
Jong Eun
JE
Byun
Kwan Soo
KS
Kim
Chang Duck
CD
Ryu
Ho Sang
HS
Um
Soon Ho
SH
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
D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D003404:Creatinine