Cystatin C is better than creatinine for predicting prognosis in cirrhotic patients with sarcopenia

초록

Background/Aims: Recent studies suggested that serum cystatin C (CysC) is a better prognostic marker than serum creatinine (Cr) for d predicting prognosis in patients with liver cirrhosis. Overestimation of renal function by serum Cr in cirrhosis patients is associated with decreased muscle mass, which is represented by sarcopenia. This study was performed to evaluate the effect of sarcopenia on the prognostic efficacy of serum Cr and CysC levels in patients with liver cirrhosis. Methods: We enrolled patients with liver cirrhosis who abdominal CT, serum Cr, and CysC levels. Patients with hepatocellular carcinoma and parenchymal renal disease were excluded. At evaluation, transverse psoas muscle thickness (TMPT) was measured on a CT image at the level of the umbilicus. Sarcopenia was defined as TPMT/height <16.8 mm/m. Results: A total of 245 patients with liver cirrhosis were enrolled. Age was 55.0±10.2 years and 159 patients (64.9%) were men. HBV infection was most common cause of underlying liver disease (118 patients, 48.2%), followed by alcoholic liver disease (87 patients, 35.5%). CTP grade was A, B, and C in 121 (49.4%), 68 (27.8%), and 56 (22.9%) patients. Sarcopenia was noted in 110 patients (44.9%), 41 (33.9%), 38 (55.9%), and 31 (55.4%) patients in CTP grade A, B, and C (P=0.003) respectively. Serum Cr level were significantly lower in patients with sarcopenia compared to those without sarcopenia (0.7±0.2 vs 0.8±0.2 mg/dL, P<0.001), while serum CysC level did not differ between two groups (1.0±0.2 vs 1.0±0.3 mg/L, P=0.970).During 23.3±26.1 months of follow-up, 32 patients (13.1%) died. Although serum CysC level was significantly associated with survival of patients with sarcopenia (P<0.001) and those without sarcopenia (P<0.001), serum Cr level was not significantly associated with survival of patients with sarcopenia (P=0.760). Conclusions: Serum CysC level was not affected by sarcopenia and it was significantly associated with mortality regardless of the presence of sarcopenia. Serum CysC level is a better option for predicting prognosis in patients with cirrhosis, especially in those with sarcopenia.