Baseline serum cystatin C as a marker of acute kidney injury in patients with acute-on-chronic liver failure

被引:8
|
作者
Jha, Praveen [1 ]
Jha, Ashish Kumar [1 ]
Dayal, Vishwa Mohan [1 ]
Jha, Sanjeev Kumar [1 ]
Kumar, Amarendra [1 ]
机构
[1] Indira Gandhi Inst Med Sci, Dept Gastroenterol, Patna 800014, Bihar, India
关键词
Acute kidney failures; Acute kidney injuries; Acute-on-chronic liver failure (ACLF); Acute-on-chronic liver failures; Chronic liver failure; Cirrhosis; Creatinine; Cystatin C; End-stage liver disease; Hepatic cirrhosis; Hepatorenal syndrome; Liver; ACUTE DECOMPENSATION; RENAL-FUNCTION; CIRRHOSIS; MORTALITY; CREATININE; PREDICTOR; DIAGNOSIS; LEVEL;
D O I
10.1007/s12664-021-01201-8
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background A creatinine-based estimation of the renal function lags behind the onset of disease process. Cystatin C is a new marker for acute kidney injury (AKI). However, data are limited in patients with acute-on-chronic liver failure (ACLF). We evaluated serum cystatin C as an early predictor of AKI in patients with ACLF. Methods In a prospective observational study, patients with ACLF and normal serum creatinine level were included in the study. Serum cystatin C was analyzed with the development of AKI and the disease outcome. Result Forty-seven patients (mean age: 43.26 +/- 16.34 years; male:female: 2.35:1) were included in the study. AKI developed in 34% of patients during the hospital stay. Receiver operating characteristic (ROC) curve analysis revealed that the best cutoff for baseline cystatin C was 1.47 mg/L with a sensitivity of 0.94 and specificity of 0.68. The cystatin C ((area under the curve [AUC]=0.853) performance was better than that of the creatinine (AUC=0.699), Child-Turcotte-Pugh (CTP) (AUC=0.661), and model for end-stage liver disease-sodium (MELD-Na) (AUC=0.641). In the univariate analysis, age, platelet count, creatinine, estimated glomerular filtration rate (eGFR)-modification of diet in renal disease (MDRD), cystatin C, and estimated glomerular filtration rate-serum cystatin C (eGFRcysC) were significantly associated with AKI in ACLF patients. Cystatin C was an independent positive predictor of AKI. Cystatin C was positively correlated with the MELD-Na scores (r=0.374 and p=0.009). Conclusion Our study supports previous studies reporting that serum cystatin C is a better predictor for AKI development compared to serum creatinine. Cystatin C may be used as an early marker for new-onset AKI in hospitalized patients with ACLF.
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收藏
页码:563 / 571
页数:9
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