Plasma Cystatin C is a predictor of renal dysfunction, ACLF and mortality in patients with acutely decompensated liver cirrhosis

Daniel Markwardt, Lesca M Holdt, Christian Steib, Andreas Benesic, Flemming Bendtsen, Mauro Bernardi, Richard Moreau, Daniel Teupser, Julia Wendon, Frederik Nevens, Jonel Trebicka, Elisabet Garcia, Marco Pavesi, Vicente Arroyo, Alexander L Gerbes

67 Citations (Scopus)


BACKGROUND: The development of acute-on-chronic liver failure (ACLF) in patients with liver cirrhosis is associated with high mortality rates. Renal failure is the most significant organ dysfunction that occurs in ACLF. So far there are no biomarkers predicting ACLF.

AIM: To investigate whether Cystatin C (CysC) and neutrophil gelatinase-associated lipocalin (NGAL) can predict development of renal dysfunction (RD), hepatorenal syndrome (HRS), ACLF and mortality, respectively.

METHODS: We determined the plasma levels of CysC and NGAL of 429 patients hospitalized for acute decompensation of cirrhosis in the CANONIC study. The patients were followed for 90 days.

RESULTS: Patients without RD or ACLF at inclusion, but with development of either, had significantly higher baseline concentrations of CysC and NGAL compared to patients without. CysC, but not NGAL was found to be predictive of RD (OR 9.4 [1.8; 49.7]), HRS (OR 4.2 [1.2; 14.8]) and ACLF (OR 5.9 [1.3; 25.9]). CysC at day3 was not found to be a better predictor than baseline CysC. CysC and NGAL were both predictive of 90 days mortality with hazard ratios for CysC of 3.1 (2.1; 4.7), and for NGAL of 1.9 (1.5; 2.4), respectively.

CONCLUSIONS: Baseline CysC is a biomarker of renal dysfunction, HRS and ACLF and an independent predictor of mortality in patients with acutely decompensated liver cirrhosis. Determining CysC at day 3 did not provide any benefit. While NGAL is also associated with short-term mortality, it fails to predict development of RD, HRS and ACLF. Baseline CysC may add to identify patients at risk earlier and might improve clinical management. This article is protected by copyright. All rights reserved.

Original languageEnglish
JournalHepatology (Baltimore, Md.)
Issue number4
Pages (from-to)1232-1241
Publication statusPublished - 1 Oct 2017


  • Journal Article


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