title: Cystatin C: a predictor of hepatorenal syndrome in patients with liver cirrhosis.
abstract: BACKGROUND
  Recent studies suggest that serum cystatin C (CysC) is a more sensitive marker of renal functions than serum creatinine (Cr).
  
  
  OBJECTIVE
  Evaluation of the clinical significance of cystatin C as a predictor of hepatorenal syndrome (HRS) in patients with liver cirrhosis, ascites, and normal serum Cr level.
  
  
  METHODS
  Eighty patients with cirrhotic ascites were enrolled in this study (53 men and 27 women; age: 59.5 ± 7.5 years). All patients were subjected to full clinical assessment and laboratory investigations focussing on renal functions, glomerular filtration rate, and measurement of serum cystatin level.
  
  
  RESULTS
  The Serum Cr and CysC levels were 1.04 ± 0.1 and 1.8 ± 0.8 mg/L, respectively. HRS developed in 18 patients during the follow-up period (6 months). Type 1 HRS was found in 5 patients and type 2 HRS was found in 13 patients with no significant difference between both types regarding baseline characteristics. Age (p < 0.001), albumin (p < 0.001), sodium (p < 0.005), cystatin C (p < 0.001), and e-GFRMDRD (estimated glomerular filtration rate-modification of the diet in renal disease) (p < 0.007) were significant dependent predictive factors for the development of HRS. The CysC level was the most independent predictive factor for HRS (OR, 2.1; 95% CI, 0.75-0.97; p < 0.002). Eighteen patients died during the follow-up period. Age (p < 0.001), INR (p < 0.001), e-GFRMDRD (p < 0.03), sodium (p < 0.01), MELD score (p < 0.05), albumin (p < 0.001), and CysC (p < 0.001) levels were significant dependent factors for predicting mortality. CysC (OR, 5.3; p < 0.006) level and INR (OR, 1.01; p < 0.006) were the most independent factors for predicting mortality.
  
  
  CONCLUSIONS
  Serum CysC level may be considered a predictor of HRS and mortality in patients with liver cirrhosis and ascites.
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Minia University, El-Minia, Egypt.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Sharawey
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Minia University, El-Minia, Egypt.
authors.forename: Eglal M
authors.initials: EM
authors.lastname: Shawky
authors.affiliation: Department of Clinical Pathology, Faculty of Medicine, Minia University, El-Minia, Egypt.
authors.forename: Lamia H
authors.initials: LH
authors.lastname: Ali
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Minia University, El-Minia, Egypt.
authors.forename: Ahmed Ali
authors.initials: AA
authors.lastname: Mohammed
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Minia University, El-Minia, Egypt.
authors.forename: Hatem A
authors.initials: HA
authors.lastname: Hassan
authors.affiliation: Department of Tropical Medicine, Faculty of Medicine, Minia University, El-Minia, Egypt. yasserfouad10@yahoo.com.
authors.forename: Yasser M
authors.initials: YM
authors.lastname: Fouad