Padia Gaurav, Mahajan Bhawana, Kumar Ajay, Sonika Ujjwal, Dahale Amol S, Sachdeva Sanjeev, Dalal Ashok, George Roshan
Department of Gastroenterology G B Pant Institute of Postgraduate Medical Education and Research (GIPMER) New Delhi India.
Department of Biochemistry G B Pant Institute of Postgraduate Medical Education and Research (GIPMER) New Delhi India.
JGH Open. 2021 Mar 9;5(4):459-464. doi: 10.1002/jgh3.12516. eCollection 2021 Apr.
Systemic inflammation and organ dysfunction/failure can complicate acute decompensation (AD) of cirrhosis with progression to acute-on-chronic liver failure (ACLF), leading to increased mortality. There are few studies on serum biomarkers predicting renal dysfunction (RD) or ACLF in AD. Serum cystatin C (CysC) and interleukin-6 (IL-6) were evaluated for predicting RD, ACLF, and mortality in AD patients.
Consecutive AD patients seen from January 2018 to June 2019 were included. IL-6 and CysC were measured in serum at the time of index presentation. Patients were followed for 90 days or until primary (development of RD) or secondary outcomes (development of ACLF or mortality). Multivariate analysis was performed to find whether CysC and IL-6 can independently predict primary and secondary outcomes.
A total of 124 patients were screened; 88 patients were included. On follow up, 22 (27.3%) developed RD, 11 (11/57, 19.3%) developed ACLF, and 21 (24%) died. The CysC predicted RD (odds ratio [OR] 7.97, 95% confidence interval [CI] 2.70-23.53, = 0.001) and ACLF (OR 5.486, 95% CI 1.456-20.6, = 0.012) development. IL-6 was not an independent predictor of RD ( = 0.315), ACLF ( = 0.168), and mortality ( = 0.225).
Serum CysC can predict the development of RD and ACLF in patients of cirrhosis with AD.
全身炎症反应及器官功能障碍/衰竭会使肝硬化急性失代偿（AD）病情复杂化，并进展为慢加急性肝衰竭（ACLF），导致死亡率升高。关于预测AD患者肾功能障碍（RD）或ACLF的血清生物标志物的研究较少。本研究评估血清胱抑素C（CysC）和白细胞介素-6（IL-6）对AD患者RD、ACLF及死亡率的预测价值。
纳入2018年1月至2019年6月期间连续就诊的AD患者。在初次就诊时检测血清IL-6和CysC水平。对患者进行90天随访，或直至出现主要结局（发生RD）或次要结局（发生ACLF或死亡）。采用多因素分析以确定CysC和IL-6是否能独立预测主要和次要结局。
共筛查124例患者，纳入88例。随访期间，22例（27.3%）发生RD，11例（11/57，19.3%）发生ACLF，21例（24%）死亡。CysC可预测RD（比值比[OR]7.97，95%置信区间[CI]2.70 - 23.53，P = 0.001）及ACLF（OR 5.486，95%CI 1.456 - 20.6，P = 0.012）的发生。IL-6不是RD（P = 0.315）、ACLF（P = 0.168）及死亡率（P = 0.225）的独立预测因素。
血清CysC可预测肝硬化AD患者RD和ACLF的发生。
