Correlation between cystasin C to disease severity of cirrhosis on model of end stage liver disease score

Heribertus Gunadi(1*), Putut Bayupurnama(2), Siti Nurdjanah(3)

(*) Corresponding Author



Background:    Cirrhosis patients  with renal failure  are  at   high   risk  for   death   and  reduced survival   as   compared   with   those   without   renal failure,  and have poor prognosis.  Some studies  have suggested   that  cystatin  C did  more  accurate   than creatinine /0  detect glomerulusfiltration    rate (GFR) in patients  with cirrhosis.  Model  of End Stage  Liver Disease  (MELD)  score  can be used in patients  with cirrhosis  with variously  Widely severity  disease  and etiologies.  Until nmv, there is no study about correlation  between  levels  of cystatin  C to disease severity  in cirrhosis based on MELD score.

Objective:  This present  study  was to investigate  the correlation  between levels of cyst at ill C with disease severity  in cirrhosis  based on MELD score.

Method:   Study  design  was cross sectional s t u d y,     This      study       was     conducted          at Gastoenterohepatology         outpatient     clinic    and Internal Medicine  ward of Dr Sardjito  General Hospital,     Yogyakarta.    Inclusion     criteria     were patients    with    cirrhosis    diagnosed     by   clinical criteria,  laboratory   and  USG.findillg,   age   >  18 years,   had  complete  medical  record  and  obtained informed consent. Exclusion criteria were chronic kidney  disease,  sepsis,  hepatocellutare   carcinoma, used high doses  of steroid,  had thyroid dysfunction. hypertension  and diabetes mellitus.

Result:   The  mean  of cystatin   C based  on categorical    MELD    score   were   MELD    <10   = 0.93±0.19   mgll;   MELD    IO-19=1.08±0.26    mg/l; MELD  20-29   =  1.25±O.27 mgll;  MELD  30-39   = 2.49 mg/l and  MELD  >40  = 2.43 mgll;  0)=0.013; 95%   CI  0.000-0.061).     There   was   a  significant correlation   between  cystatin  C to MELD  score  as demonstrated   byp=O.OOOand r=0.485.

Conclusion:     Our  data  suggested    a significant     correlation     with   medium    strength between cystatin  C to severity  disease  of cirrhosis based 011 MELD score.


Keywords:  cirrhosis,  cystatin  C, MELD score



Full Text:



Gines, P. and Schrier, R.W. Renal failure in cirrhosis. N Engl J Med. 2009; 361. 1279-90.

Elaine, Y., Florence, W., Elaine, Y. Renal Dysfunction in Cirrhosis: Diagnosis, Treatment, and Prevention. MedGen 2004; 6 (4):9.

Cholongitas, E., Papatheodoridis, G.V., Vangei, M., Terreni, N., Patch, D., Burroughs, A.K. , Systematic review: the model for end-stage liver Disease-should it replace Child-Pugh’s classification for assessing prognosis in cirrhosis?. Aliment Pharmacol Ther 2005; 22: 1079-1089.

Thomas, L., Huber, A.R. Renal Function: Estimation of Glomerular filtration rate. Clin Chem Lab Med 2006; 44: 1295-1302.

Pika, M.B., Nina, C. Human Cystatin C. Turkisj J Biochem 2007; 32(3): 95-103.

Poge, U., Gerhardt, T., Stoffel-Wagner, B., Klehr, H. U., Sauerbruch, T., Woitas, R, P, Calculation of Glomerular filtration rate based on Cystatin C in Cirrhotic patients. Nephrol Dial Transplant 2006; 21: 660-64.

Durand, F., Valla, D. Assessment of the Prognosis of Cirrhosis: Child-Pugh versus MELD. J Hepatol 2005; S100-7.

Chan, H.L.Y., Chim, A.M.L., Lau, J.T.F., Hui, A.Y., Wong, V.W.S., Sung, J.J.Y, Evaluation of model for end-stage liver disease for prediction of mortality in decompensated chronic hepatitis B. Am J Gastroenterol 2006; 101: 1516-23.

Caregaro, L., Menon, F., Angeli, P., Amodio, P., Merkel, C., Bortoluzzi, A., Alberino, F., Gatta, A, Limitations of Serum Creatinine Level and Creatinine Clearance as Filtration Markers in Cirrhosis. Arch Intern Med 1994; 154 : 201-05.

Said, A., Williams, J., Holden, J., Remington, P., Gangnon, R., Musat, A., Lucey, M.R, Model for end-stage liver disease score predicts mortality across a broad spectrum of liver disease. J Hepatol 2004; 40: 897-903.

Schepke, M., Appenrodt, B., Heller, J., Zielinski, J., Sauerbruch, T, Prognostic Factors for Patients with Cirrhosis and Kidney Dysfunction in the Era of MELD: Results of a Prospective Study. Liver Intern. 2006; 26(7):834-39.

Jiang, M., Liu, F., Xiong, W., Zhong, L, Chen, X. Comparison of four model for end-stage liver disease in evaluating the prognosis of cirrhosis. Word J Gastroenterol 2008;14 (42): 6546-50.

Kamath, P.S., Wiesner, R.H., Malinhoc, M., Kremers, W., Therneau, T.M., Kosberg, C.L., D’amico, G., Dickson, E.R., Kim, W.R, A model to predict survival in patients with end stage liver disease. J Hepatol 2001; 33: 464-70.

MacAulay, J., Thompson, K., Kiberd, B.A., Barnes, D.C., Peltekian, K.M, Serum Creatinine in patents with advanced liver disease is of limited value for identification of moderate renal dysfunction: Are the equations for estimating renal function better? Can J Gastroenterol 2006; 20; 8: 521-26.

D’Amico, G., Garcia-Tsao, G., Pagliaro, L. Natural history and prognostic indicators of survival in cirrhosis: A systematic review of 118 studies. J Hepatol 2006; 44: 217-31.

Fleming, K.M., Aithal, G.P., Dodaran, M.S., Card, T.R., Joe West, J, Incidence and prevalence of cirrhosis in the United Kingdom, 1992-2001: A general population-based study. J. Hepato: 2008; 49; 5: 732-8.

Orlando, R. Mussap, M., Plebani, M., Piccoli, P, De Martin, S., Floreani, M., Padrini, R., Palatini, P, Diagnostic Value of Plasma Cystatin C as a Glomerular Filtration Marker in Decompensated Liver Cirrhosis. Clin Chem 2002; 48; 6: 850-58.

Botta, F., Giannini, E., Romagnoli, P., Fasoli, A., Malfatti, F., Chiarbonello, B., Testa., Risso, D., Colla, G., Testa, PMELD scoring system is useful for predicting prognosis in patients with liver cirrhosis and is correlated with residual liver function: a European study. Gut 2003; 52:134-39.

Poge, U., Gerhardt, T., Stoffel-Wagner, B., Klehr, H, U., Sauerbruch, T., Woitas, R, P, Calculation of glomerular filtration rate based on Cystatin C in cirrhotic patients. Nephrol Dial Transplant 2006; 21: 660-64.

Gines, A., Escorsell, A., Gines, P. Incidence, predictive factors, and diagnosis of the hepatorenal syndrome in cirrhosis with ascites. Gastroenterol. 1993; 105: 229-37.

Takeuchi, M., Fukuda, Y., Nakano, I., Katano, Y., Hayakawwa, T, 2001. Elevation of serum cystatin C in patients with chronic liver disease. Eur J Gastroenterol Hepatol 2001; 13: 951-5.

Goldberg, E., Chopra. S. Diagnostic approach to the patient with cirrhosis. Uptodate 17.1.2008.

Christopher, C., Armelle, P.R., Dominique, W., Marie, G., Yves, C., Reene, E.P., Robert, P, Biochemical markers of liver fibrosis and lymphocytic piecemeal necrosis in UDCA-treated patients with primary biliary cirrhosis. Liver Int 2004; 24: 3 341-44.

Sherlock, S. and Dooley, J. Hepatic Cirrhosis. In: Disease of Liver and Biliary System. Blackwell Publishing Ltd. Oxford. 2002 365-77.

Laterza, O, F., Price, C.P., Scott, M.G. Cystatin C: An Improved Estimator of Glomerular Filtration Rate? Clin Chem 2002; 699-707.

Woitas, P., Stoffel-Wagner, B., Flommersfeld, S., Poege, U., Schneidermeier, P., Klehr, H.U., Spengler, U., Bidlingmaier, F., Sauerbruch, T, Correlation of Serum Concentrations of Cystatin C and Creatinine to Inulin in Liver Cirrhosis. Clin Chem 2000; 46: 5: 712-15.

El-Agourdy, A.E., Sabry, A.A., Ghanen, H.A., El-Baz, A., Fakry, A., Gad, H.M., Sheashaa, H.A., Abdel-Hamid, M., Youseff, M., Mokhtar, A.E.A, Serum Cystatin C: A Good Marker for Evaloation of Glomerular Filtration Rate in Hepatorenal Syndrome. Eur J Gen Med 2004; 4: 29-35.

Arroyo, V. and Jimenez, W. Complications of Cirrhosis. Renal and Circulatory dysfunction lights and shadows in an important clinical problem. J Hepatol 2000; 32; 157-70.


Article Metrics

Abstract views : 383 | views : 110


  • There are currently no refbacks.

Copyright (c) 2011 Acta Interna The Journal of Internal Medicine

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Acta Interna The Journal of Internal Medicine Indexed by:


 Indonesia Onesearch Google Scholar IPI Indonesian Publication Index

 website statistics View My Stats  



Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.