title: Glomerular filtration rate is an independent factor of mortality in patients with decompensated cirrhosis.
abstract: OBJECTIVE
  Although serum creatinine is included in the Model for End-Stage Liver Disease (MELD) score, it is an inaccurate marker of renal function, namely, of glomerular filtration rate ("true" GFR) in patients with decompensated cirrhosis. Our aim was to investigate the impact of MELD score and "true" GFR as determinants of survival in patients with decompensated cirrhosis.
  
  
  METHODS
  We included all consecutive patients with decompensated cirrhosis who were admitted to our department. Renal function was assessed by creatinine- and cystatin-based estimated GFR and "true" GFR using (51) Cr-ethylenediaminetetraacetic acid. The independent factors associated with survival were evaluated. The discriminative ability of the prognostic scores (MELD and modifications of MELD score) were evaluated by using the area under the receiver-operator curve (AUC).
  
  
  RESULTS
  One hundred and ten consecutive patients (77 men, aged 56 ± 12 years); at the end of follow up (8 months; range, 6-18), 92 patients (84%) were alive and 18 (16%) had died. In multivariate analysis, serum bilirubin (hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.05-1.26; P = 0.020) and "true" GFR (HR, 0.96; 95% CI, 0.93-0.98; P = 0.003) were the only independent factors significantly associated with the outcome. The derived new prognostic model had high discriminative ability (AUC, 0.90), which was confirmed in the validation sample of 77 patients.
  
  
  CONCLUSIONS
  In our cohort of patients with decompensated cirrhosis, "true" GFR and bilirubin were the independent factors of the outcome.
authors.affiliation: 4th Department of Internal Medicine, Medical School of Aristotle University, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Cholongitas
authors.forename: George
authors.initials: G
authors.lastname: Arsos
authors.forename: John
authors.initials: J
authors.lastname: Goulis
authors.forename: Charis
authors.initials: C
authors.lastname: Birtsou
authors.forename: Anna-Bettina
authors.initials: AB
authors.lastname: Haidich
authors.forename: Theodora
authors.initials: T
authors.lastname: Nakouti
authors.forename: Parthenis
authors.initials: P
authors.lastname: Chalevas
authors.forename: Maria
authors.initials: M
authors.lastname: Ioannidou
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Karakatsanis
authors.forename: Evangelos
authors.initials: E
authors.lastname: Akriviadis
keywords: Model for End-Stage Liver Disease score; cirrhosis; glomerular filtration rate; prognosis