Cystatin C: a predictor of hepatorenal syndrome in patients with liver cirrhosis

Hepatol Int. 2011 Dec;5(4):927-33. doi: 10.1007/s12072-011-9266-y. Epub 2011 Mar 12.


Background: Recent studies suggest that serum cystatin C (CysC) is a more sensitive marker of renal functions than serum creatinine (Cr).

Aim: Evaluation of the clinical significance of cystatin C as a predictor of hepatorenal syndrome (HRS) in patients with liver cirrhosis, ascites, and normal serum Cr level.

Methods: Eighty patients with cirrhotic ascites were enrolled in this study (53 men and 27 women; age: 59.5 ± 7.5 years). All patients were subjected to full clinical assessment and laboratory investigations focussing on renal functions, glomerular filtration rate, and measurement of serum cystatin level.

Results: The Serum Cr and CysC levels were 1.04 ± 0.1 and 1.8 ± 0.8 mg/L, respectively. HRS developed in 18 patients during the follow-up period (6 months). Type 1 HRS was found in 5 patients and type 2 HRS was found in 13 patients with no significant difference between both types regarding baseline characteristics. Age (p < 0.001), albumin (p < 0.001), sodium (p < 0.005), cystatin C (p < 0.001), and e-GFRMDRD (estimated glomerular filtration rate-modification of the diet in renal disease) (p < 0.007) were significant dependent predictive factors for the development of HRS. The CysC level was the most independent predictive factor for HRS (OR, 2.1; 95% CI, 0.75-0.97; p < 0.002). Eighteen patients died during the follow-up period. Age (p < 0.001), INR (p < 0.001), e-GFRMDRD (p < 0.03), sodium (p < 0.01), MELD score (p < 0.05), albumin (p < 0.001), and CysC (p < 0.001) levels were significant dependent factors for predicting mortality. CysC (OR, 5.3; p < 0.006) level and INR (OR, 1.01; p < 0.006) were the most independent factors for predicting mortality.

Conclusion: Serum CysC level may be considered a predictor of HRS and mortality in patients with liver cirrhosis and ascites.

Keywords: Cystatin C; Hepatorenal syndrome; Liver cirrhosis.