CYSTATIN C AS AN EARLY MARKER OF HEPATORENAL SYNDROME

Abstract

The research was aimed to investigate the use of cystatin C (CysC) for early detection of hepatorenal syndrome (HRS) in cirrhotics. CysC, a low-molecular-weight cysteine proteinase inhibitor, is a potentially more accurate marker of glomerular filtration. We conducted a prospective multicenter study in patients with alcoholic liver cirrhosis, comparing changes in CysC and serum creatinine (Scr) immediately following onset of HRS as predictors of a composite endpoint of dialysis or mortality. The results of our study confirmed, that CysC has demonstrated less variability between samples than Scr. Patients were stratified into four groups reflecting changes in Scr and cystatin: both unchanged or decreased 38 (36%) (Scr−/CysC−); only cystatin increased 25 (24%) (Scr−/CysC+); only Scr increased 15 (14%) (Scr+/CysC−); and both increased 28 (26%) (Scr+/CysC+). With Scr−/CysC− as the reference, in both instances where cystatin rose, Scr−/CysC+ and Scr+/CysC+, the primary outcome was significantly more frequent in multivariate analysis, and, respectively. However, when only Scr rose, outcomes were similar to the reference group. Summarizing all above, we can conclude, that changes in CysC levels early in HRS are more closely associated with eventual dialysis or mortality, than Scr and may allow more rapid identification of patients at risk for adverse outcomes.