Korean J Hepatol.  2010 Sep;16(3):301-307. 10.3350/kjhep.2010.16.3.301.

Diagnostic value of cystatin C for predicting acute kidney injury in patients with liver cirrhosis

• Chung MY
• Jun DW
• Sung SA

• KMID: 1717325
• DOI: http://doi.org/10.3350/kjhep.2010.16.3.301

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.

Keyword

Cystatin C; Liver cirrhosis; Acute kidney injury

MeSH Terms

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