title: Cystatin C is a biomarker for predicting acute kidney injury in patients with acute-on-chronic liver failure.
abstract: OBJECTIVE
  To investigate serum cystatin C level as an early biomarker for predicting acute kidney injury (AKI) in patients with acute-on-chronic liver failure (ACLF).
  
  
  METHODS
  Fifty-six consecutive patients with hepatitis B virus-related ACLF who had normal serum creatinine (Cr) level (< 1.2 mg/dL in men, or < 1.1 mg/dL in women) were enrolled in the Liver Failure Treatment and Research Center of Beijing 302 Hospital between August 2011 and October 2012. Thirty patients with chronic hepatitis B (CHB) and 30 healthy controls in the same study period were also included. Measurement of serum cystatin C (CysC) was performed by a particle-enhanced immunonephelometry assay using the BN Prospec nephelometer system. The ACLF patients were followed during their hospitalization period.
  
  
  RESULTS
  In the ACLF group, serum level of CysC was 1.1 ± 0.4 mg/L, which was significantly higher (P < 0.01) than those in the healthy controls (0.6 ± 0.3 mg/L) and CHB patients (0.7 ± 0.2 mg/L). During the hospitalization period, eight ACLF patients developed AKI. Logistic regression analysis indicated that CysC level was an independent risk factor for AKI development (odds ratio = 1.8; 95%CI: 1.4-2.3, P = 0.021). The cutoff value of serum CysC for prediction of AKI in ACLF patients was 1.21 mg/L. The baseline CysC-based estimated glomerular filtration rate (eGFR(CysC)) was significantly lower than the creatinine-based eGFR (eGFR(CG) and eGFR(MDRD)) in ACLF patients with AKI, suggesting that baseline eGFR(CysC) represented early renal function in ACLF patients while the Cr levels were still within the normal ranges.
  
  
  CONCLUSIONS
  Serum CysC provides early prediction of renal dysfunction in ACLF patients with a normal serum Cr level.
authors.affiliation: Zhi-Hong Wan, Jian-Jun Wang, Shao-Li You, Hong-Ling Liu, Bing Zhu, Hong Zang, Chen Li, Jing Chen, Shao-Jie Xin, Liver Failure Treatment and Research Center, Beijing 302 Hospital, Beijing 100039, China.
authors.forename: Zhi-Hong
authors.initials: ZH
authors.lastname: Wan
authors.affiliation: Zhi-Hong Wan, Jian-Jun Wang, Shao-Li You, Hong-Ling Liu, Bing Zhu, Hong Zang, Chen Li, Jing Chen, Shao-Jie Xin, Liver Failure Treatment and Research Center, Beijing 302 Hospital, Beijing 100039, China.
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Wang
authors.affiliation: Zhi-Hong Wan, Jian-Jun Wang, Shao-Li You, Hong-Ling Liu, Bing Zhu, Hong Zang, Chen Li, Jing Chen, Shao-Jie Xin, Liver Failure Treatment and Research Center, Beijing 302 Hospital, Beijing 100039, China.
authors.forename: Shao-Li
authors.initials: SL
authors.lastname: You
authors.affiliation: Zhi-Hong Wan, Jian-Jun Wang, Shao-Li You, Hong-Ling Liu, Bing Zhu, Hong Zang, Chen Li, Jing Chen, Shao-Jie Xin, Liver Failure Treatment and Research Center, Beijing 302 Hospital, Beijing 100039, China.
authors.forename: Hong-Ling
authors.initials: HL
authors.lastname: Liu
authors.affiliation: Zhi-Hong Wan, Jian-Jun Wang, Shao-Li You, Hong-Ling Liu, Bing Zhu, Hong Zang, Chen Li, Jing Chen, Shao-Jie Xin, Liver Failure Treatment and Research Center, Beijing 302 Hospital, Beijing 100039, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Zhu
authors.affiliation: Zhi-Hong Wan, Jian-Jun Wang, Shao-Li You, Hong-Ling Liu, Bing Zhu, Hong Zang, Chen Li, Jing Chen, Shao-Jie Xin, Liver Failure Treatment and Research Center, Beijing 302 Hospital, Beijing 100039, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Zang
authors.affiliation: Zhi-Hong Wan, Jian-Jun Wang, Shao-Li You, Hong-Ling Liu, Bing Zhu, Hong Zang, Chen Li, Jing Chen, Shao-Jie Xin, Liver Failure Treatment and Research Center, Beijing 302 Hospital, Beijing 100039, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Li
authors.affiliation: Zhi-Hong Wan, Jian-Jun Wang, Shao-Li You, Hong-Ling Liu, Bing Zhu, Hong Zang, Chen Li, Jing Chen, Shao-Jie Xin, Liver Failure Treatment and Research Center, Beijing 302 Hospital, Beijing 100039, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
authors.affiliation: Zhi-Hong Wan, Jian-Jun Wang, Shao-Li You, Hong-Ling Liu, Bing Zhu, Hong Zang, Chen Li, Jing Chen, Shao-Jie Xin, Liver Failure Treatment and Research Center, Beijing 302 Hospital, Beijing 100039, China.
authors.forename: Shao-Jie
authors.initials: SJ
authors.lastname: Xin
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D000328:Adult; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood*; D042241:Early Diagnosis; D058625:End Stage Liver Disease / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications; D006801:Humans; D017114:Liver Failure, Acute / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009391:Nephelometry and Turbidimetry; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012307:Risk Factors; D013997:Time Factors; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D003404:Creatinine
keywords: Acute kidney injury; Acute-on-chronic liver failure; Creatinine; Cystatin C; Prediction