Serum Cystatin C is Superior to Serum Creatinine for Detection of Acute Kidney Injury in Cirrhotic Patients with Upper Gastrointestinal Bleeding
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- Category: Vol. 80, December 2012
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Serum Cystatin C is Superior to Serum Creatinine for Detection of Acute Kidney Injury in Cirrhotic Patients with Upper Gastrointestinal Bleeding,HALA I.M. HUSSIEN, NOHA E. SHAHEN, MARAWAN M. ATIYAH, ALAA A. FARG and HODA A. IBRAHEEM
Abstract
Background: Cirrhotic patients are sensitive to decreased plasma volume, making renal failure a relatively frequent event when they are presented with upper gastrointestinal (GI) bleeding. Serum creatinine does not represent the true renal function in cirrhotic patients resulting in significant delay in diagnosis of acute kidney injury (AKI). Therefore, parameters of moderately impaired renal function are of great clinical importance.
Aim of the Study: We aimed to evaluate the role of serum cystatin C as a biomarker for early and accurate diagnosis of AKI in cirrhotic patients presented with upper GI bleeding.
Subjects and Methods: The study included 60 cirrhotic patients presented with upper GI bleeding and subjected to upper GI endoscopy, in addition to 20 cirrhotic patients without upper GI bleeding and 15 healthy individuals as controls. They had been evaluated as regard medical history, clinical manifestations, liver and kidney functions including serum creatinine and creatinine clearance. Estimation of serum cystatin C was done using ELISA.
Results: Thirty percent (30%) of cirrhotic patients pre-sented with upper GI bleeding developed criteria suggesting AKI during the period of hospitalization (according to acute kidney injury network criterion). At admission, there was no significant difference between patients with AKI versus those without as regard serum cystatin C (p=0.77) and serum creat-inine (p=0.85). Six hours after admission, patients with AKI had highly significant elevation in serum cystatin C in com-parison with its levels at admission. The elevated serum cystatin C levels after 6 hours were significantly high in patients with AKI in comparison with all groups. In contrast to serum creatinine levels which remained within the normal range and did not show significant increase in patients with AKI in comparison with the bleeding cirrhotic patients without AKI or cirrhotic patients, but were significantly higher than those of healthy individuals. Serum cystatin C levels had a significant positive correlation with serum creatinine and a significant negative correlation with creatinine clearance, but it had no correlation with Child-Pugh score among patients with AKI. As regard the diagnostic validity of serum cystatin C in detection of AKI in cirrhotic patients with upper GI bleeding, at a cutoff value of 1.18 mg/dL, serum cystatin C yielded sensitivity 94.4%, specificity 88.1 %, positive predictive value (PPV) 77.2%, and negative predictive value (NPV) 97.3%.
Conclusions: Serum cystatin C was superior to serum creatinine in detection of AKI in cirrhotic patients with upper GI bleeding. So, it had better advantage over creatinine as it can improve clinical outcome of AKI by early diagnosis before any rise of serum creatinine allowing rapid management.