Benefit of cystatin C in evaluation of renal function and prediction of survival in patients with cirrhosis. Issue 13 (10th April 2015)

• Record Type: Journal Article
• Authors: Adachi, Meguru; Tanaka, Atsushi; Aiso, Mitsuhiko; Takamori, Yoriyuki; Takikawa, Hajime
• Is Part Of: Hepatology research. Volume 45:Issue 13(2015:Dec.)
• Page Start: 1299
• Page End: 1306
• Publication Date: 2015-04-10
• Subjects: cystatin C -- glomerular filtration rate -- creatinine -- outcome; Liver -- Diseases -- Periodicals; Liver Diseases -- Periodicals; Foie -- Maladies -- Périodiques; 616.362
• DOI: 10.1111/hepr.12508
• Languages: English
• ISSNs: 1386-6346

Abstract

Abstract: Aim: The assessment of renal function is of vital importance in management of patients with cirrhosis. While serum creatinine (Cr) is routinely used for this purpose, Cr‐based estimated glomerular filtration rate (eGFR) does not reflect true renal function because of muscle wasting and impaired liver function. By contrast, cystatin C (CysC) is unrelated to muscle volume and liver function. In this study, we examined whether CysC‐based GFR estimation is beneficial in assessment of renal function in patients with cirrhosis. Methods: First, we assessed the performance of GFR‐predicting equations based on serum Cr or CysC in 14 patients with cirrhosis, by comparison with inulin clearance as a gold standard of GFR (measured GFR [mGFR]). Next, in 49 patients with cirrhosis, we examined serum Cr and CysC at baseline, and examined which GFR‐predicting equations were more suitable for predicting the outcome. Results: In the first experiment, mGFR was 54.3 ± 23.0 mL/min, and CysC‐based GFR‐estimating equations had better performances compared with Cr‐based equations in terms of bias, precision and accuracy. Cr‐based estimated GFR (eGFRcreat) was significantly different from mGFR ( P < 0.05). In the follow‐up study of 49 patients (observational period, 30.7 ± 32.0 months), multivariate analysis demonstrated that CysC‐based estimated GFR (eGFRcys), along with albumin, Child–Pugh grade and presence of hepatocellular carcinoma, was independently associated with overall survival (odds ratio, 4.19; 95% confidence interval, 1.44–12.2, P = 0.009). Conclusion: These results suggest that eGFRcys could estimate renal function and predict outcome more accurately compared with Cr‐based eGFR in cirrhotic patients.