Cystatin C: a predictor of hepatorenal syndrome in patients with liver cirrhosis
Cystatin C: a predictor of hepatorenal syndrome in patients with liver cirrhosis
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DOI：
10.1007/s12072-011-9266-y
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发表时间：
2011-12-01
影响因子：
6.6
通讯作者：
Fouad, Yasser M.
中科院分区：
文献类型：
--
作者：
Sharawey, Mohammed A.;Shawky, Eglal M.;Fouad, Yasser M.
背景近年来研究表明血清胱抑素C（CysC）是一种比血清肌酐（Cr）更敏感的肾功能指标，目的探讨CysC在肝硬化腹水和血清Cr正常患者中预测肝肾综合征（HRS）的临床意义（53名男性和27名女性;年龄：59.5 +/- A 7.5岁）。所有患者均进行了全面的临床评估和实验室检查，重点是肾功能，肾小球滤过率和血清胱抑素水平的测量。在随访期间（6个月），18例患者发生HRS。在5例患者中发现1型HRS，在13例患者中发现2型HRS，两种类型之间的基线特征无显著差异。年龄（p < 0.001）、白蛋白（p < 0.001）、钠（p < 0.005）、胱抑素C（p < 0.001）和e-GFR（MDRD）（估计肾小球滤过率-肾脏疾病饮食调整）（p < 0.007）是HRS发生的重要依赖性预测因素。CysC水平是HRS最独立的预测因素（OR，2.1; 95%CI，0.75-0.97; p < 0.002）。18例患者在随访期间死亡。年龄（p < 0.001）、INR（p < 0.001）、e-GFR（MDRD）（p < 0.03）、钠（p < 0.01）、MELD评分（p < 0.05）、白蛋白（p < 0.001）和CysC（p < 0.001）水平是预测死亡率的重要依赖因素。CysC（OR，5.3;结论血清CysC水平可作为肝硬化腹水患者HRS及病死率的预测指标。
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 +/- A 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 +/- A 0.1 and 1.8 +/- A 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-GFR(MDRD) (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-GFR(MDRD) (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.