title: Urine albumin-to-creatinine ratio is associated with the severity of liver disease, renal function and survival in patients with decompensated cirrhosis.
abstract: OBJECTIVE
  To investigate if urine albumin-to-creatinine ratio (UACR) is associated with the presence of glomerular filtration rate (GFR) <60 mL/min, severity of liver disease and survival in patients with stable decompensated cirrhosis.
  
  
  METHODS
  We evaluated prospectively 220 patients (73 % male, age 52.8 ± 12 years). In each patient, assessment of GFR was based on51chromium-EDTA. Random urine samples were obtained for measurement of UACR.
  
  
  RESULTS
  Thirty-eight patients (17 %, group 1) had UACR ≥30 mg/g and 182 (83 %, group 2) had UACR <30 mg/g. Group 1, compared to group 2 patients, had significantly lower levels of "true" GFR (61 vs. 71 ml/min, p = 0.035). Patients with "true" GFR <60 mL/min (n = 93), compared to those with "true" GFR ≥60 mL/min (n = 127), had higher levels of UACR (16 vs. 11.3 mg/g, p = 0.023). In multivariate analysis, serum creatinine and UACR (ΟR 0.98, 95 % CI 0.95-0.99, p = 0.04) were independently associated with the presence of GFR <60 mL/min. Based on the area under the ROC curves, the best cut-off point for UACR was >16.51 mg/g giving a sensitivity 70 %, specificity 49 %, PPV 68 % and NPV 51 %. During the follow-up period [17 (6-52) months], the patients who died or underwent LT (n = 158), compared to those who remained alive (n = 62), had higher levels of UACR (41 vs. 13 mg/g, p = 0.025). Patients with UACR ≥30 mg/g had worse outcome, compared to those with UACR <30 mg/g (log rank p = 0.053).
  
  
  CONCLUSIONS
  We showed for the first time that UACR ≥30 mg/g was associated with more severe liver disease, lower GFR and worse LT-free survival in patients with decompensated cirrhosis. However, further studies are needed to confirm these findings.
authors: 4th Department of Internal Medicine, Hippokration General Hospital of Thessaloniki, Medical School Aristotle University of Thessaloniki, 49, Konstantinopoleos Street, 54642, Thessaloniki, Greece. cholongitas@yahoo.gr.
authors: Evangelos
authors: E
authors: Cholongitas
authors: 4th Department of Internal Medicine, Hippokration General Hospital of Thessaloniki, Medical School Aristotle University of Thessaloniki, 49, Konstantinopoleos Street, 54642, Thessaloniki, Greece.
authors: Ioannis
authors: I
authors: Goulis
authors: 4th Department of Internal Medicine, Hippokration General Hospital of Thessaloniki, Medical School Aristotle University of Thessaloniki, 49, Konstantinopoleos Street, 54642, Thessaloniki, Greece.
authors: Maria
authors: M
authors: Ioannidou
authors: 4th Department of Internal Medicine, Hippokration General Hospital of Thessaloniki, Medical School Aristotle University of Thessaloniki, 49, Konstantinopoleos Street, 54642, Thessaloniki, Greece.
authors: Stergios
authors: S
authors: Soulaidopoulos
authors: 4th Department of Internal Medicine, Hippokration General Hospital of Thessaloniki, Medical School Aristotle University of Thessaloniki, 49, Konstantinopoleos Street, 54642, Thessaloniki, Greece.
authors: Parthenis
authors: P
authors: Chalevas
authors: 4th Department of Internal Medicine, Hippokration General Hospital of Thessaloniki, Medical School Aristotle University of Thessaloniki, 49, Konstantinopoleos Street, 54642, Thessaloniki, Greece.
authors: Evangelos
authors: E
authors: Akriviadis
mesh_terms: D000328:Adult; D000418:Albumins / Q000032:analysis*; D000419:Albuminuria / Q000652:urine*; D003404:Creatinine / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications* / Q000401:mortality / Q000652:urine; D008107:Liver Diseases / Q000097:blood / Q000150:complications / Q000473:pathology* / Q000652:urine; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D013534:Survival
chemical_list: D000418:Albumins; D003404:Creatinine
keywords: Albumin-to-creatinine ratio; Decompensated cirrhosis; Glomerular filtration rate; MELD score; Outcome; Renal function