Evaluation of serum cystatin C concentration as a

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Gut 2002 Jan;50(1):106-110 Evaluation of serum cystatin C concentration as a marker of renal function in patients with cirrhosis of the liver. Gerbes AL, Gulberg V, Bilzer M, Vogeser M Department of Medicine II, Klinikum of the University of Munich-Grosshadern, Munich, Germany Institute for Clinical Chemistry, Klinikum of the University of Munich-Grosshadern, Munich, Germany. [Record supplied by publisher] Background and aims: Diagnosis of moderately impaired renal function is of particular importance in patients with cirrhosis of the liver. Whereas patients with a markedly impaired glomerular filtration rate can be diagnosed easily by elevated serum creatinine concentrations, moderately reduced renal function may be missed by this conventional parameter. Recently, cystatin C has been suggested as a sensitive marker of renal function, independent of sex or muscle mass. Therefore, the aim of this study was to investigate the value of serum cystatin C concentration for the detection of moderately impaired renal function. Methods: Ninety seven inhospital patients with cirrhosis and a 24 hour creatinine clearance of at least 40 ml/min were investigated and divided into group 1 (creatinine clearance >/=70 ml/min; n=55) and group 2 (creatinine clearance 40-69 ml/min; n=42). Results: Serum cystatin C concentrations (mean (SD): 1.31 (0.51) v 1.04 (0.34) mg/l (p=0.008)) and creatinine concentrations (1.03 (0.52) v 0.86 (0.22) mg/100 ml (p=0.03)) were higher in group 2 than in group 1; there was no significant difference in urea concentrations. Receiver-operator characteristics (ROC) revealed a differential diagnostic advantage of cystatin C over creatinine and urea. At cut off concentrations of 1.0 mg/l, 0.9 mg/100 ml, and 28 mg/100 ml, respectively, cystatin C, creatinine, and urea exhibited 69%, 45%, and 44% sensitivity (p<0.05). As patients with a small muscle mass or reduced physical activity could be particularly prone to overestimation of their renal function, separate analyses were performed for the subgroups of female and Child-Pugh class C patients, respectively. In both groups, discrimination between patients with moderately impaired and normal renal function was best with cystatin C. In female patients, sensitivity of cystatin C (77.8%) was superior (p<0.05) to that of creatinine (38.9%) and urea (41.2%). In Child-Pugh C patients, the ROC curve was significantly better for cystatin C than for creatinine. Conclusions: Serum cystatin C determination could be a valuable tool in patients with cirrhosis, particularly with Child-Pugh class C or in female patients, for early diagnosis of moderately impaired renal function. PMID: 11772976 =============== Sheree Martin mailto:[email protected] Co-Owner Hepatitis B Info & Support List http://www.geocities.com/Heartland/Estates/9350/hblist.html Hepatitis Glossary:http://www.geocities.com/Mamablondie/hepterms.html _______________________________________________________________ A blank message to these addresses performs the following - [email protected] gets you on the list. [email protected] gets you off the list. [email protected] toggles you to/from the fancy digest version. [email protected] toggles you to/from the vacation list. [email protected] posts your message to the list.