Plasma Cystatin C Level is a Prognostic Marker of Morbidity and Mortality in Hospitalized Decompensated Cirrhotic Patients

Introduction : Cystatin C (CysC) is biomarker for early detection of acute kidney injury (AKI). How-ever, there is limited evidence in decompensated cirrhotic patients without AKI at admission. This study aimed to assess CysC as a predictor of 90-day mortality. Methods : Decompensated cirrhotic patients without AKI were prospectively enrolled. CysC and creatinine were measured within 24 hours of admission and compared be-tween patients with in-hospital complications (AKI, hepatorenal syndrome (HRS), acute-on-chronic liver failure (ACLF)) vs. those without, and survivors vs. non-survivors. The AUROC and cut-off point of CysC in predicting 90-day mortality were determined. Results : Of 137 decompensated cirrhotic patients, 46 without AKI at admis-sion were included (58.7% male, age 60.8 +/- 11.2years, MELD 13.1 +/- 5.1, ChildA/B/C 43.5%/39.1%/17.4%). The mean CysC level tended to be higher in patients with ACLF (1.52 +/- 0.60 vs. 1.11 +/- 0.28, p = 0.05), and significantly higher in non-survivors than survivors (1.61 +/- 0.53 vs. 1.08 +/- 0.28, p = 0.013). The 90-day mortality rate was 21.7%. After ad-justing with age and bacterial infection on admission, CysC level >= 1.25 mg/L was significantly associated with 90-day mortality. The CysC cut-off level >= 1.25 mg/L provided 80% sensitivity and 75% specificity for predicting 90-day mortality. Conclusion : Plasma CysC within 24 hours could be used as a predictor for 90-day mortality and development of ACLF in decompensated cirrhotic patients.