Sex specificity of kidney markers to assess prognosis in cirrhotic patients with TIPS.
Adolescent
Adult
Aged
Aged, 80 and over
Biomarkers
/ blood
Cohort Studies
Creatinine
/ blood
Cystatin C
/ blood
Female
Germany
Glomerular Filtration Rate
Humans
Intramolecular Oxidoreductases
/ blood
Kidney Diseases
/ diagnosis
Lipocalins
/ blood
Liver Cirrhosis
/ blood
Male
Middle Aged
Portasystemic Shunt, Transjugular Intrahepatic
Prognosis
Severity of Illness Index
Sex Factors
Survival Analysis
Young Adult
beta-trace protein
cirrhosis
cystatin C
portal hypertension
renal function
Journal
Liver international : official journal of the International Association for the Study of the Liver
ISSN: 1478-3231
Titre abrégé: Liver Int
Pays: United States
ID NLM: 101160857
Informations de publication
Date de publication:
01 2020
01 2020
Historique:
received:
30
05
2019
revised:
18
07
2019
accepted:
20
08
2019
pubmed:
27
8
2019
medline:
24
3
2021
entrez:
27
8
2019
Statut:
ppublish
Résumé
Renal function assessed by creatinine is a key prognostic factor in cirrhotic patients. However, creatinine is influenced by several factors, rendering interpretation difficult in some situations. This is especially important in early stages of renal dysfunction where renal impairment might not be accompanied by an increase in creatinine. Other parameters, such as cystatin C (CysC) and beta-trace protein (BTP), have been evaluated to fill this gap. However, none of these studies have considered the role of the patient's sex. The present study analysed CysC and BTP to evaluate their prognostic value and differentiate them according to sex. CysC and BTP were measured in 173 transjugular intrahepatic portosystemic shunt (TIPS)-patients from the NEPTUN-STUDY(NCT03628807) and analysed their relationship with mortality and sex. Propensity score for age, MELD, etiology and TIPS indication was used. Cystatin C and BTP showed excellent correlations with creatinine values at baseline and follow-up. CysC was an independent predictor of overall mortality (HR = 1.66(1.33-2.06)) with an AUC of 0.75 and identified a cut-off of 1.55 mg/L in the whole cohort. Interestingly, CysC was significantly lower in females, also after propensity score matching. In males, the only independent predictor was the creatinine level (HR = 1.54(1.25-1.58)), while in females CysC levels independently predicted mortality (HR = 3.17(1.34-7.52)). This study demonstrates for the first time that in TIPS-patients creatinine predicts mortality in males better than in females, whereas CysC is a better predictor of mortality in females. These results may influence future clinical decisions on therapeutic options for example, allocation for liver transplantation in TIPS-patients.
Sections du résumé
BACKGROUND & AIMS
Renal function assessed by creatinine is a key prognostic factor in cirrhotic patients. However, creatinine is influenced by several factors, rendering interpretation difficult in some situations. This is especially important in early stages of renal dysfunction where renal impairment might not be accompanied by an increase in creatinine. Other parameters, such as cystatin C (CysC) and beta-trace protein (BTP), have been evaluated to fill this gap. However, none of these studies have considered the role of the patient's sex. The present study analysed CysC and BTP to evaluate their prognostic value and differentiate them according to sex.
PATIENTS AND METHODS
CysC and BTP were measured in 173 transjugular intrahepatic portosystemic shunt (TIPS)-patients from the NEPTUN-STUDY(NCT03628807) and analysed their relationship with mortality and sex. Propensity score for age, MELD, etiology and TIPS indication was used.
RESULTS
Cystatin C and BTP showed excellent correlations with creatinine values at baseline and follow-up. CysC was an independent predictor of overall mortality (HR = 1.66(1.33-2.06)) with an AUC of 0.75 and identified a cut-off of 1.55 mg/L in the whole cohort. Interestingly, CysC was significantly lower in females, also after propensity score matching. In males, the only independent predictor was the creatinine level (HR = 1.54(1.25-1.58)), while in females CysC levels independently predicted mortality (HR = 3.17(1.34-7.52)).
CONCLUSION
This study demonstrates for the first time that in TIPS-patients creatinine predicts mortality in males better than in females, whereas CysC is a better predictor of mortality in females. These results may influence future clinical decisions on therapeutic options for example, allocation for liver transplantation in TIPS-patients.
Substances chimiques
Biomarkers
0
Cystatin C
0
Lipocalins
0
Creatinine
AYI8EX34EU
Intramolecular Oxidoreductases
EC 5.3.-
prostaglandin R2 D-isomerase
EC 5.3.99.2
Banques de données
ClinicalTrials.gov
['NCT03628807']
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
186-193Informations de copyright
© 2019 The Authors. Liver International published by John Wiley & Sons Ltd.
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