Plasma cystatin C is a predictor of renal dysfunction, acute‐on‐chronic liver failure, and mortality in patients with acutely decompensated liver cirrhosis

Markwardt, Daniel; Holdt, Lesca M.; Steib, Christian; Benesic, Andreas; Bendtsen, Flemming; Bernardi, Mauro; Moreau, Richard; Teupser, Daniel; Wendon, Julia; Nevens, Frederik; Trebicka, Jonel; García, Elisabet; Pavesi, Marco; Arroyo, Vicente; Gerbes, Alexander L.

doi:10.1002/hep.29290

Cited by 84 publications

(94 citation statements)

References 41 publications

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“…Not surprisingly, renal dysfunction and coagulation dysfunction seem to be highly associated with the development of ACLF after surgery in patients with Child‐Pugh grade A. This is in line with previous findings, which attribute a special role to renal and coagulation function in the development of ACLF …”

Section: Discussionsupporting

confidence: 91%

The Development and Outcome of Acute‐on‐Chronic Liver Failure After Surgical Interventions

Klein¹,

Chang²,

et al. 2019

Liver Transpl

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Acute-on-chronic liver failure (ACLF) is a syndrome with high short-term mortality. Precipitating events, including hemorrhage and infections, contribute to ACLF development, but the role of surgery remains unknown. We investigated the development of ACLF in patients with cirrhosis undergoing surgery. In total, 369 patients with cirrhosis were included in the study. The clinical and laboratory data were collected prior to and on days 1-2, 3-8, and 9-28, and at 3 and 12 months after surgery. Surgery type was classified as limited or extensive, as well as liver and nonliver surgery. A total of 39 patients had baseline ACLF. Surgery was performed during acute decompensation in 35% of the rest of the 330 patients, and 81 (24.5%) developed ACLF within 28 days after surgery. Surrogate markers of systemic inflammation were similar in patients who developed ACLF or not. Age, sex, serum sodium, baseline bacterial infection, and abdominal nonliver surgery were independent predictors for the development of ACLF after surgery. Patients who developed ACLF within 28 days after surgery had a higher mortality at 3, 6, and 12 months. Survival did not differ between patients with ACLF at surgery and those developing ACLF after surgery. Development of ACLF within 28 days after surgery and elevated alkaline phosphatase and international normalized ratio were independent predictors of 90-day mortality. Independent predictors of 1-year all-cause mortality were alkaline phosphatase, Model for End-Stage Liver Disease score, and preoperative hepatic encephalopathy, whereas nonliver surgery was associated with improved survival. ACLF frequently develops in patients with cirrhosis undergoing surgery, especially in those with active bacterial infection, lower serum sodium, and kidney or coagulation dysfunction. Prognoses of ACLF both at and after surgery are similarly poor. Patients with cirrhosis should be carefully managed perioperatively.Liver Transplantation 26 227-237 2020 AASLD.

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Section: Discussionsupporting

confidence: 91%

The Development and Outcome of Acute‐on‐Chronic Liver Failure After Surgical Interventions

Klein¹,

Chang²,

et al. 2019

Liver Transpl

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“…CysC was also a predictor for predicting the development of ACLF. Recently, Markwardt et al [80] measured the plasma levels of CysC in 429 patients hospitalized for acutely decompensated cirrhosis and results showed that the baseline CysC level was not only a predictor of renal dysfunction (OR: 9.4) but also a predictor of HRS, ACLF, and 90-day mortality (OR: 4.2, 5.9, and 3.1, respectively). Maiwall et al [81] developed AKI-Score including bilirubin, Cystatin C, and prior AKI to predict the new AKI in patients with LC.…”

Section: Predicting the Renal Injurymentioning

confidence: 99%

Fluid Biomarkers for Predicting the Prognosis of Liver Cirrhosis

Chen

Wan

Wang

et al. 2020

BioMed Research International

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Liver cirrhosis is the terminal stage of most chronic liver conditions, with a high risk of mortality. Careful evaluation of the prognosis of cirrhotic patients and providing precise management are crucial to reduce the risk of mortality. Although the liver biopsy and hepatic venous pressure gradient (HVPG) can efficiently evaluate the prognosis of cirrhotic patients, their application is limited due to the invasion procedures. Child-Pugh score and the model for end-stage liver disease (MELD) score had been widely used in the assessment of cirrhotic prognosis, but the defects of subjective variable application in Child-Pugh score and unsuitability to all phases of liver cirrhosis in MELD score limit their prognostic values. In recent years, continuous efforts have been made to investigate the prognostic value of body fluid biomarkers for cirrhotic patients, and promising results have been reported. Since the collection of fluid specimens is easy, noninvasive, and repeatable, fluid biomarkers can be ideal indicators to predict the prognosis of cirrhosis. Here, we reviewed noninvasive fluid biomarkers in different prognostic functions, including the prediction of survival and complication development.

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“…Neuere Untersuchungen weisen darauf hin, dass die Bestimmung von Cystatin C im Blut und Urin sowohl als aussagekräftiger Prädiktor für HRS-AKI, Non-HRS-AKI, ACLF und Mortalität als auch zur Differenzierung zwischen einer akuten Tubulusnekrose und einem HRS-AKI verwendet werden kann [81][82][83]. Die lokal eingeschränkte Verfügbarkeit und die hohen Kosten des Reagens haben bislang eine breite Anwendung in der klinischen Praxis nicht erlaubt.…”

Section: Serumkreatinin Gfr Harnstoff Und Cystatin C Als Marker Derunclassified

Paradigmenwechsel im Verständnis der akuten Nierenschädigung bei chronischer Leberinsuffizienz: Von der Pathophysiologie zur Definition von Krankheitsentitäten

et al. 2020

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ZusammenfassungSeit den ersten Beschreibungen von Patienten mit Aszites und fortgeschrittener Leberzirrhose durch Helvig und Schutz in den 1930er- und weiteren Obduktionsstudien von Hecker und Sherlock in den 1960er-Jahren wird das gleichzeitige Vorliegen einer Nierenfunktionsstörung als hepatorenales Syndrom (HRS) bezeichnet. Forschungsarbeiten der letzten Jahre liefern Hinweise, dass insbesondere systemische Entzündungsreaktionen einen kritischen Punkt in der Pathogenese der dekompensierten Leberzirrhose darstellen und maßgeblich an der Entstehung eines akut-auf-chronischen Leberversagens (ACLF) und einer Nierenfunktionsstörung beteiligt sind.Das HRS ist nur ein Aspekt des Spektrums der Nierenschädigung in Zirrhosepatienten. Die fortgeschrittene chronische Lebererkrankung per se bzw. ihre Ätiologie, aber auch weitere begleitende komorbide systemische Erkrankungen bzw. deren Komplikationen wie Diabetes, Adipositas und Hypertonie können direkt zu parenchymatösen Veränderungen (z. B. Gallensäurenephropathie, ischämische Tubulusepithelzellnekrose, diabetische Nephropathie, Glomerulonephritiden assoziiert mit Hepatitis B und C usw.) führen. Diese Art der Nierenschädigung wird deskriptiv als Non-HRS-AKI bezeichnet.In der vorliegenden Übersicht konzentrieren wir uns auf die neue Definition, Klassifikation und die zugrunde liegenden pathophysiologischen Mechanismen für das HRS, HRS-AKI und Non-HRS-AKI und untersuchen in dieser Hinsicht den diagnostischen und prognostischen Stellenwert neuerer Serum- und Urinmarker.

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Plasma cystatin C is a predictor of renal dysfunction, acute‐on‐chronic liver failure, and mortality in patients with acutely decompensated liver cirrhosis

Cited by 84 publications

References 41 publications

The Development and Outcome of Acute‐on‐Chronic Liver Failure After Surgical Interventions

The Development and Outcome of Acute‐on‐Chronic Liver Failure After Surgical Interventions

Fluid Biomarkers for Predicting the Prognosis of Liver Cirrhosis

Paradigmenwechsel im Verständnis der akuten Nierenschädigung bei chronischer Leberinsuffizienz: Von der Pathophysiologie zur Definition von Krankheitsentitäten

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