title: Cystatin C is a strong predictor of survival in patients with cirrhosis: is a cystatin C-based MELD better?
abstract: OBJECTIVE
  The model of end stage liver disease (MELD) includes serum creatinine, which is a poor surrogate marker of renal function in patients with cirrhosis. Especially in women and patients with advanced disease creatinine underestimates true renal function. Our objective was to assess whether or not the substitution of creatinine by cystatin C improves the prognostic performance of the model.
  
  
  METHODS
  The association between MELD parameters and cystatin C with survival was investigated using a Cox proportional hazards model. A cystatin C-based MELD score was calculated from the results and compared with creatinine-based MELD in terms of discrimination and calibration.
  
  
  RESULTS
  Four hundred and twenty-nine patients were included in the study; 19% died and 12% underwent liver transplantation during a median follow-up of 602 days. In multivariate Cox regression, cystatin C was an independent predictor of 90-day mortality with a hazard ratio of 8.0 (95% CI: 2.2-29.6). The median cystatin C-based MELD was 15, the median creatinine-based MELD was 12. Calibration and discrimination for 3 month and 1 year mortality was similar between the scores (AUC > 0.85 for both scores). Gender differences in cystatin C-based MELD were less pronounced than those in the creatinine-based model, because creatinine but not cystatin C was affected by gender.
  
  
  CONCLUSIONS
  Substitution of creatinine by cystatin C does not improve the predictive power of MELD.
authors.affiliation: Department of Medicine II-Gastroenterology and Hepatology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Armin
authors.initials: A
authors.lastname: Finkenstedt
authors.forename: Livia
authors.initials: L
authors.lastname: Dorn
authors.forename: Michael
authors.initials: M
authors.lastname: Edlinger
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Prokop
authors.forename: Lorenz
authors.initials: L
authors.lastname: Risch
authors.forename: Andrea
authors.initials: A
authors.lastname: Griesmacher
authors.forename: Ivo
authors.initials: I
authors.lastname: Graziadei
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Vogel
authors.forename: Heinz
authors.initials: H
authors.lastname: Zoller
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood*; D058625:End Stage Liver Disease / Q000097:blood* / Q000401:mortality*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution
chemical_list: D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D003404:Creatinine