Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Dec 28, 2013; 19(48): 9432-9438
Published online Dec 28, 2013. doi: 10.3748/wjg.v19.i48.9432
Cystatin C is a biomarker for predicting acute kidney injury in patients with acute-on-chronic liver failure
Zhi-Hong Wan, Jian-Jun Wang, Shao-Li You, Hong-Ling Liu, Bing Zhu, Hong Zang, Chen Li, Jing Chen, Shao-Jie Xin
Zhi-Hong Wan, Jian-Jun Wang, Shao-Li You, Hong-Ling Liu, Bing Zhu, Hong Zang, Chen Li, Jing Chen, Shao-Jie Xin, Liver Failure Treatment and Research Center, Beijing 302 Hospital, Beijing 100039, China
Author contributions: Wan ZH designed and performed the experiments, analyzed the data and wrote the manuscript; Xin SJ designed the study and revised the manuscript; Wang JJ performed the experiments and analyzed the data; You SL and Liu HL enrolled the patients and collected clinical data; Zhu B, Chen J, Zang H and Li C collected human materials and revised the manuscript; and all authors have read and approved the final manuscript.
Supported by Beijing Municipal Science and Technology Commission, No. Z131107002213018; and partially by grants from the 12th Five-Year National Science and Technology Major Project for Infectious Diseases, No. 2012ZX10002004-005
Correspondence to: Shao-Jie Xin, MD, Professor, Director, Liver Failure Treatment and Research Center, Beijing 302 Hospital, 100 Xisihuan Middle Road, Beijing 100039, China. xinshaojie302@163.com
Telephone: +86-10-66933433 Fax: +86-10-66933434
Received: September 25, 2013
Revised: November 4, 2013
Accepted: November 12, 2013
Published online: December 28, 2013
Abstract

AIM: To investigate serum cystatin C level as an early biomarker for predicting acute kidney injury (AKI) in patients with acute-on-chronic liver failure (ACLF).

METHODS: Fifty-six consecutive patients with hepatitis B virus-related ACLF who had normal serum creatinine (Cr) level (< 1.2 mg/dL in men, or < 1.1 mg/dL in women) were enrolled in the Liver Failure Treatment and Research Center of Beijing 302 Hospital between August 2011 and October 2012. Thirty patients with chronic hepatitis B (CHB) and 30 healthy controls in the same study period were also included. Measurement of serum cystatin C (CysC) was performed by a particle-enhanced immunonephelometry assay using the BN Prospec nephelometer system. The ACLF patients were followed during their hospitalization period.

RESULTS: In the ACLF group, serum level of CysC was 1.1 ± 0.4 mg/L, which was significantly higher (P < 0.01) than those in the healthy controls (0.6 ± 0.3 mg/L) and CHB patients (0.7 ± 0.2 mg/L). During the hospitalization period, eight ACLF patients developed AKI. Logistic regression analysis indicated that CysC level was an independent risk factor for AKI development (odds ratio = 1.8; 95%CI: 1.4-2.3, P = 0.021). The cutoff value of serum CysC for prediction of AKI in ACLF patients was 1.21 mg/L. The baseline CysC-based estimated glomerular filtration rate (eGFRCysC) was significantly lower than the creatinine-based eGFR (eGFRCG and eGFRMDRD) in ACLF patients with AKI, suggesting that baseline eGFRCysC represented early renal function in ACLF patients while the Cr levels were still within the normal ranges.

CONCLUSION: Serum CysC provides early prediction of renal dysfunction in ACLF patients with a normal serum Cr level.

Keywords: Acute-on-chronic liver failure, Cystatin C, Creatinine, Acute kidney injury, Prediction

Core tip: Severe renal dysfunction often occurs in patients with acute-on-chronic liver failure (ACLF) due to circulatory abnormalities and inflammation. New biomarkers with higher reliability and specificity for monitoring renal function are required. Fifty-six patients with ACLF and normal serum creatinine (Cr) were enrolled. Our results showed that patients who developed acute kidney injury during hospitalization had significantly higher basal serum cystatin C (CysC) levels. CysC-based estimated glomerular filtration rate more accurately represented renal function in ACLF patients. CysC can be used as an early biomarker for detection of renal dysfunction in patients with ACLF before any increase in serum Cr is detected.