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Serum cystatin C level: An excellent predictor of mortality in patients with cirrhotic ascites
Yeon Seok Seo1, Soo Young Park2, Moon Young Kim3
1Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Insights
Serum cystatin C effectively predicts mortality and hepatorenal syndrome in cirrhotic ascites patients. Unlike serum creatinine, cystatin C offers a more reliable prognostic marker for assessing liver cirrhosis outcomes.
Area of Science:
- Nephrology
- Hepatology
- Clinical Biochemistry
Background:
- Liver cirrhosis with ascites presents significant prognostic challenges.
- Serum creatinine is a common but potentially inaccurate renal function marker in this population.
- The prognostic value of serum cystatin C in cirrhotic ascites requires further investigation.
Purpose of the Study:
- To evaluate the prognostic efficacy of serum cystatin C levels.
- To compare cystatin C with serum creatinine for predicting mortality and hepatorenal syndrome type 1 (HRS-1).
Main Methods:
- Prospective enrollment of 350 patients with cirrhotic ascites across 15 centers.
- Utilized Cox regression analyses to identify independent predictors of mortality and HRS-1.
- Assessed serum creatinine and cystatin C levels as potential prognostic markers.
Main Results:
- Serum cystatin C levels independently predicted both mortality and HRS-1 development.
- Serum creatinine levels did not show significant association with mortality or HRS-1.
- International normalized ratio, serum bilirubin, and serum sodium were also identified as predictors.
Conclusions:
- Serum cystatin C is a superior independent predictor of mortality and HRS-1 in cirrhotic ascites.
- Replacing serum creatinine with cystatin C in predictive models may improve patient assessment and prognosis.
- This finding supports the utility of cystatin C in managing patients with advanced liver disease.
Background And Aim:
Although serum cystatin C level is considered a more accurate marker of renal function in patients with liver cirrhosis, its prognostic efficacy remains uncertain. This study aimed to evaluate the prognostic efficacy of serum cystatin C level in patients with cirrhotic ascites.
Methods:
Patients with cirrhotic ascites from 15 hospitals were prospectively enrolled between September 2009 and March 2013. Cox regression analyses were performed to identify independent predictive factors of mortality and development of type 1 hepatorenal syndrome (HRS-1).
Results:
In total, 350 patients were enrolled in this study. The mean age was 55.4 ± 10.8 years, and 267 patients (76.3%) were men. The leading cause of liver cirrhosis was alcoholic liver disease (64.3%), followed by chronic viral hepatitis (29.7%). Serum creatinine and cystatin C levels were 0.9 ± 0.4 mg/dL and 1.1 ± 0.5 mg/L, respectively. Multivariate analyses revealed that international normalized ratio and serum bilirubin, sodium, and cystatin C levels were independent predictors of mortality and international normalized ratio and serum sodium and cystatin C levels were independent predictors of the development of HRS-1. Serum creatinine level was not significantly associated with mortality and development of HRS-1 on multivariate analysis.
Conclusion:
Serum cystatin C level was an independent predictor of mortality and development of HRS-1 in patients with cirrhotic ascites, while serum creatinine level was not. Predictive models based on serum cystatin C level instead of serum creatinine level would be more helpful in the assessment of the condition and prognosis of patients with cirrhotic ascites.
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