Maria Torner1,2,3, Adjmal Mangal4, Hubert Scharnagl5, Christian Jansen4, Michael Praktiknjo4, Alexander Queck6, Wenyi Gu1,6,7, Robert Schierwagen6, Jennifer Lehmann4, Frank E Uschner7, Christiana Graf7, Christian P Strassburg4, Javier Fernandez1,3, Tatjana Stojakovic8, Rainer Woitas4, Jonel Trebicka1,7,9,10. 1. European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain. 2. Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Spain. 3. Liver ICU, Liver Unit, Hospital Clinic y Provencial de Barcelona, Barcelona, Spain. 4. Department of Internal Medicine I, University of Bonn, Bonn, Germany. 5. Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria. 6. Translational Hepatology, Department of Internal Medicine I, University Clinic Frankfurt, Frankfurt, Germany. 7. Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. 8. Clinical Institute of Medical and Chemical Laboratory Diagnostics, University Hospital Graz, Graz, Austria. 9. Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark. 10. Institute for Bioengineering of Catalonia, Barcelona, Spain.
Abstract
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.
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-patientscreatinine 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.
Authors: Benedikt Simbrunner; Andrea Beer; Katharina Wöran; Fabian Schmitz; Christian Primas; Marlene Wewalka; Matthias Pinter; Werner Dolak; Bernhard Scheiner; Andreas Puespoek; Michael Trauner; Georg Oberhuber; Mattias Mandorfer; Thomas Reiberger Journal: Wien Klin Wochenschr Date: 2020-01-07 Impact factor: 1.704
Authors: Theresa H Wirtz; Philipp A Reuken; Christian Jansen; Petra Fischer; Irina Bergmann; Christina Backhaus; Christoph Emontzpohl; Johanna Reißing; Elisa F Brandt; M Teresa Koenen; Kai M Schneider; Robert Schierwagen; Maximilian J Brol; Johannes Chang; Henning W Zimmermann; Nilay Köse-Vogel; Thomas Eggermann; Ingo Kurth; Christian Stoppe; Richard Bucala; Jürgen Bernhagen; Michael Praktiknjo; Andreas Stallmach; Christian Trautwein; Jonel Trebicka; Tony Bruns; Marie-Luise Berres Journal: JHEP Rep Date: 2020-12-17
Authors: Jin Ge; Jennifer C Lai; Justin Richard Boike; Margarita German; Nathaniel Jest; Giuseppe Morelli; Erin Spengler; Adnan Said; Alexander Lee; Alexander Hristov; Archita P Desai; Shilpa Junna; Bhupesh Pokhrel; Thomas Couri; Sonali Paul; Catherine Frenette; Nathaniel Christian-Miller; Marcela Laurito; Elizabeth C Verna; Usman Rahim; Aparna Goel; Arighno Das; Stewart Pine; Dyanna Gregory; Lisa B VanWagner; Kanti Pallav Kolli Journal: Liver Transpl Date: 2021-01-02 Impact factor: 5.799