由胱抑素C定义的急性肾损伤在预测肝硬化合并急性消化道出血的预后方面可能更具优势。
Acute kidney injury defined by cystatin C may be superior for predicting the outcomes of liver cirrhosis with acute gastrointestinal bleeding.
作者信息
Hong Cen, Zhu Qiang, Li Yiling, Tang Shanhong, Lin Su, Yang Yida, Yuan Shanshan, Shao Lichun, Wu Yunhai, Liu Bang, Li Bimin, Meng Fanping, Chen Yu, Hong Min, Qi Xingshun
机构信息
Department of Gastroenterology, General Hospital of Northern Theater Command (formally called General Hospital of Shenyang Military Area), Shenyang, China.
Department of Gastroenterology, Shandong Provincial Hospital, Shandong Frist Medical University, Jinan, China.
出版信息
Ren Fail. 2022 Dec;44(1):398-406. doi: 10.1080/0886022X.2022.2039193.
BACKGROUND & AIMS: Acute kidney injury (AKI) is conventionally evaluated by a dynamic change of serum creatinine (Scr). Cystatin C (CysC) seems to be a more accurate biomarker for assessing kidney function. This retrospective multicenter study aims to evaluate whether AKI re-defined by CysC can predict the in-hospital outcomes of patients with liver cirrhosis and acute gastrointestinal bleeding.
METHODS
Overall, 677 cirrhotic patients with acute gastrointestinal bleeding, in whom both Scr and CysC levels were detected at admissions, were screened. eGFR, eGFR, and eGFR were calculated. MELD-Na score and AKI were re-evaluated by CysC instead of Scr. Odds ratios (ORs) were calculated in the logistic regression analyses. The receiver operating characteristic (ROC) curve analyses were performed.
RESULTS
Univariate logistic regression analyses demonstrated that baseline Scr and CysC levels, eGFR, eGFR, eGFR, original MELD-Na score defined by Scr, MELD-Na score re-defined by CysC, and AKI re-defined by CysC, but not conventional AKI defined by Scr, were significantly associated with in-hospital death. ROC analyses showed that baseline CysC level, eGFR, eGFR, eGFR, original MELD-Na score defined by Scr, and MELD-Na score re-defined by CysC, but not baseline Scr level, could significantly predict the risk of in-hospital death.
CONCLUSIONS
AKI re-defined by CysC may be superior for predicting the in-hospital mortality of cirrhotic patients with acute gastrointestinal bleeding.
背景与目的
急性肾损伤（AKI）传统上通过血清肌酐（Scr）的动态变化来评估。胱抑素C（CysC）似乎是评估肾功能更准确的生物标志物。这项回顾性多中心研究旨在评估由CysC重新定义的AKI是否能预测肝硬化合并急性胃肠道出血患者的住院结局。
方法
总共筛选了677例肝硬化合并急性胃肠道出血的患者，这些患者入院时均检测了Scr和CysC水平。计算了估算肾小球滤过率（eGFR）。用CysC而非Scr重新评估终末期肝病模型钠（MELD-Na）评分和AKI。在逻辑回归分析中计算比值比（OR）。进行了受试者工作特征（ROC）曲线分析。
结果
单因素逻辑回归分析表明，基线Scr和CysC水平、eGFR、由Scr定义的原始MELD-Na评分、由CysC重新定义的MELD-Na评分以及由CysC重新定义的AKI，但不是由Scr定义的传统AKI，与住院死亡显著相关。ROC分析表明，基线CysC水平、eGFR、由Scr定义的原始MELD-Na评分以及由CysC重新定义的MELD-Na评分，但不是基线Scr水平，可显著预测住院死亡风险。
结论
由CysC重新定义的AKI在预测肝硬化合并急性胃肠道出血患者的住院死亡率方面可能更具优势。
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