Diagnostic value of cystatin C for predicting acute kidney injury in patients with liver cirrhosis.
10.3350/kjhep.2010.16.3.301
- Author:
Mi Yeon CHUNG
1
;
Dae Won JUN
;
Su Ah SUNG
Author Information
1. Department of Internal Medicine, Eulji University School of Medicine, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Cystatin C;
Liver cirrhosis;
Acute kidney injury
- MeSH:
Acute Kidney Injury/complications/*diagnosis/mortality;
Adult;
Aged;
Creatinine/blood;
Cystatin C/*analysis/blood/urine;
Female;
Humans;
Liver Cirrhosis/blood/*complications;
Male;
Middle Aged;
Multivariate Analysis;
Predictive Value of Tests;
ROC Curve;
Risk Factors;
Severity of Illness Index;
Survival Rate
- From:The Korean Journal of Hepatology
2010;16(3):301-307
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: The present study aimed to determine the role of cystatin C as a prognostic factor for acute kidney injury and survival in cirrhotic patients. METHODS: The study investigated 53 liver cirrhosis patients. The renal function was evaluated by serum creatinine, serum and urine cystatin C, and 24-hour creatinine clearance on admission. Acute kidney injury was defined as a serum creatinine level exceeding the normal range (>1.2 mg/dl) and an increase of at least 50% from the baseline value. Multivariate analysis, receiver operating characteristic curve, and survival analysis were used to investigate prognostic factors for acute kidney injury and survival. RESULTS: Nine of the 53 cirrhotic patients (17.0%) developed acute kidney injury within 3 months. Both serum creatinine and cystatin C were predictive factors for acute kidney injury in univariate analysis, with a diagnostic accuracy of 0.735 (95% confidence interval (CI), 0.525-0.945; p=0.028) for serum cystatin C and 0.698 (95% CI, 0.495-0.901, p=0.063) for creatinine. In multivariate analysis, only serum cystatin C was an independent risk factor for acute kidney injury. The sensitivity and specificity of a serum cystatin C level of >1.23 mg/L to acute kidney injury were 66% and 86%, respectively. Serum cystatin C was positively correlated with the Model for End-Stage Liver Disease (MELD) and MELD-Na scores (r=0.346 and p=0.011, and r=0.427 and p=0.001, respectively). Comparison of the survival rates over the observation period revealed that a serum cystatin C level of >1.23 mg/L was a useful marker for short-term mortality (p<0.001). CONCLUSIONS: The accuracy in predicting acute kidney injury and short-term mortality was higher for a serum cystatin C level of >1.23 mg/L than for the serum creatinine concentration in patients with cirrhosis.
