中文｜English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 40 Issue 2
Feb.  2024
Turn off MathJax
Article Contents
Article Navigation >  Journal of Clinical Hepatology  > 2024  >  40(2): 264-270

Value of serum creatinine-to-cystatin C ratio in assessing the prognosis of hepatitis B virus-related acute-on-chronic liver failure

DOI: 10.12449/JCH240208

  • Department of Infectious Diseases，The First Affiliated Hospital of Soochow University，Suzhou，Jiangsu 215000，China

Research funding:

National S & T Major Project (2017ZX10203201002-002)

More Information
  • Corresponding author: GAN Jianhe， ganjianhe2023@163.com （ORCID： 0009-0001-3837-2745）
  • Received Date: 2023-05-26
  • Accepted Date: 2023-06-27
  • Published Date: 2024-02-19
    Abstract
  •   Objective  To investigate the clinical value of serum creatinine-to-cystatin C ratio （CCR） in evaluating the prognosis of hepatitis B virus-related acute-on-chronic liver failure （HBV-ACLF）.  Methods  A retrospective analysis was performed for the clinical data of 130 patients with HBV-ACLF （treatment group） who were hospitalized in Department of Infectious Diseases， The First Affiliated Hospital of Soochow University， from January 2021 to November 2022. According to the treatment outcome， they were divided into survival group with 87 patients and death group with 43 patients； according to the presence or absence of infection， they were divided into infection group with 37 patients and non-infection group with 93 patients. A total of 30 individuals who underwent physical examination during the same period of time were enrolled as control group. Routine blood test results were collected on the day of admission， including white blood cell count， platelet count， neutrophil count， and lymphocyte count； serum creatinine， cystatin C， serum albumin （Alb）， and prothrombin time （PT） were observed on the day of admission and on days 5， 10， and 15 of hospitalization， and related indicators were calculated， including CCR， neutrophil-to-lymphocyte ratio （NLR）， platelet-to-lymphocyte ratio （PLR）， prognostic nutritional index （PNI）， CCR5 （CCR on day 5 after admission）， ΔCCR5 （CCR on day 5 after admission minus CCR on the day of admission）， CCR10 （CCR on day 10 after admission）， ΔCCR10 （CCR on day 10 after admission minus CCR on day 5 after admission）， CCR15 （CCR on day 15 after admission）， and ΔCCR15 （CCR on day 15 after admission minus CCR on day 10 after admission）. The above indicators were compared between the survival group and the death group and between the infection group and the non-infection group. The Mann-Whitney U test was used for comparison of continuous data between two groups， and the Kruskal-Wallis H test was used for comparison between multiple groups. The univariate and multivariate logistic regression analyses were used to investigate the influencing factors for disease prognosis； the receiver operating characteristic （ROC） curve was used to assess the value of CCR in predicting HBV-ACLF death events， and the DeLong test was used for comparison of the area under the ROC curve （AUC）.  Results  There were significant differences in CCR， NLR， PNI， PT， and Alb at baseline between the treatment group and the healthy control group （all P<0.001）， and there were significant differences in CCR， NLR， and PT between the survival group and the death group on the day of admission （all P<0.05）. Among the 130 patients with HBV-ACLF， there were 25 in the precancerous stage， 48 in the early stage， 32 in the intermediate stage， and 25 in the advanced stage， and there were significant differences in baseline CCR， PLR， and PT between the patients in different stages of HBV-ACLF （all P<0.05）. There were significant differences in ΔCCR5 and NLR between the infection group and the non-infection group （P<0.05）， and there were significant differences in ΔCCR5， CCR10， and CCR15 between the survival group and the death group （all P<0.05）. The multivariate logistic regression analysis showed that ΔCCR5 （odds ratio ［OR］=1.175， 95% confidence interval ［CI］： 1.098‍ — ‍1.256， P<0.001）， NLR （OR=0.921， 95%CI： 0.880‍ — ‍0.964， P<0.001）， and PT （OR=0.921， 95%CI： 0.873‍ — ‍0.973， P=0.003） were independent influencing factors for the prognosis of HBV-ACLF patients. ΔCCR5 had an AUC of 0.774， a sensitivity of 0.687， and a specificity of 0.757， and the AUC of ΔCCR5+PT+NLR was 0.824， which was significantly higher than the AUC of ΔCCR5， NLR， or PT alone （all P<0.05）.  Conclusion  ΔCCR5， NLR， and PT can reflect the condition and prognosis of patients with HBV-ACLF and are independent predictive indicators for death events in patients with HBV-ACLF. The combination ofΔCCR5， PT， and NLR has the best predictive efficiency.

     

    • FullText(HTML)
  • loading
    • References(29)
  • [1]
    Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Gastroenterology, Chinese Medical Association. Clinical guidelines on nutrition in end-stage liver disease[J]. J Clin Hepatol, 2019, 35( 6): 1222- 1230. DOI: 10.3969/j.issn.1001-5256.2019.06.010.

    中华医学会肝病学分会, 中华医学会消化病学分会. 终末期肝病临床营养指南[J]. 临床肝胆病杂志, 2019, 35( 6): 1222- 1230. DOI: 10.3969/j.issn.1001-5256.2019.06.010.
    [2]
    MANGANA DEL RIO T, SACLEUX SC, VIONNET J, et al. Body composition and short-term mortality in patients critically ill with acute-on-chronic liver failure[J]. JHEP Rep, 2023, 5( 8): 100758. DOI: 10.1016/j.jhepr.2023.100758.
    [3]
    NISHIKAWA H, SHIRAKI M, HIRAMATSU A, et al. Japan Society of Hepatology guidelines for sarcopenia in liver disease(1st edition): Recommendation from the working group for creation of sarcopenia assessment criteria[J]. Hepatol Res, 2016, 46( 10): 951- 963. DOI: 10.1111/hepr.12774.
    [4]
    PENG H, ZHANG Q, LUO L, et al. A prognostic model of acute-on-chronic liver failure based on sarcopenia[J]. Hepatol Int, 2022, 16( 4): 964- 972. DOI: 10.1007/s12072-022-10363-2.
    [5]
    SANCHEZ-RODRIGUEZ D, MARCO E, CRUZ-JENTOFT AJ. Defining sarcopenia: Some caveats and challenges[J]. Curr Opin Clin Nutr Metab Care, 2020, 23( 2): 127- 132. DOI: 10.1097/MCO.0000000000000621.
    [6]
    SAYER AA, CRUZ-JENTOFT A. Sarcopenia definition, diagnosis and treatment: Consensus is growing[J]. Age Ageing, 2022, 51( 10): afac220. DOI: 10.1093/ageing/afac220.
    [7]
    KASHANI KB, FRAZEE EN, KUKRÁLOVÁ L, et al. Evaluating muscle mass by using markers of kidney function: Development of the sarcopenia index[J]. Crit Care Med, 2017, 45( 1): e23- e29. DOI: 10.1097/CCM.0000000000002013.
    [8]
    WANG S, XIE L, XU J, et al. Predictive value of serum creatinine/cystatin C in neurocritically ill patients[J]. Brain Behav, 2019, 9( 12): e01462. DOI: 10.1002/brb3.1462.
    [9]
    JUNG CY, KIM HW, HAN SH, et al. Creatinine-cystatin C ratio and mortality in cancer patients: A retrospective cohort study[J]. J Cachexia Sarcopenia Muscle, 2022, 13( 4): 2064- 2072. DOI: 10.1002/jcsm.13006.
    [10]
    Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association; Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association. Guideline for diagnosis and treatment of liver failure(2018)[J]. J Clin Hepatol, 2019, 35( 1): 38- 44. DOI: 10.3969/j.issn.1001-5256.2019.01.007.

    中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018年版)[J]. 临床肝胆病杂志, 2019, 35( 1): 38- 44. DOI: 10.3969/j.issn.1001-5256.2019.01.007.
    [11]
    LI JQ, LIANG X, YOU SL, et al. Development and validation of a new prognostic score for hepatitis B virus-related acute-on-chronic liver failure[J]. J Hepatol, 2021, 75( 5): 1104- 1115. DOI: 10.1016/j.jhep.2021.05.026.
    [12]
    GAO FY, ZHANG QQ, LIU Y, et al. Nomogram prediction of individual prognosis of patients with acute-on-chronic hepatitis B liver failure[J]. Dig Liver Dis, 2019, 51( 3): 425- 433. DOI: 10.1016/j.dld.2018.08.023.
    [13]
    SUN ZY, LIU XL, WU DX, et al. Circulating proteomic panels for diagnosis and risk stratification of acute-on-chronic liver failure in patients with viral hepatitis B[J]. Theranostics, 2019, 9( 4): 1200- 1214. DOI: 10.7150/thno.31991.
    [14]
    BEER L, BASTATI N, BA-SSALAMAH A, et al. MRI-defined sarcopenia predicts mortality in patients with chronic liver disease[J]. Liver Int, 2020, 40( 11): 2797- 2807. DOI: 10.1111/liv.14648.
    [15]
    JIN L, LI X. MRI-defined sarcopenia predicts mortality in patients with chronic liver disease[J]. Liver Int, 2021, 41( 1): 223. DOI: 10.1111/liv.14691.
    [16]
    WANG T, ZHANG YG, LI QQ, et al. Evaluation value of area index of the third lumbar psoas major muscle in nutritional status and prognosis of patients with cirrhosis[J]. Clin J Med Offic, 2022, 50( 7): 729- 732. DOI: 10.16680/j.1671-3826.2022.07.18.

    王然, 张永国, 李谦谦, 等. 第三腰椎腰大肌面积指数对肝硬化患者营养状态及预后评估价值[J]. 临床军医杂志, 2022, 50( 7): 729- 732. DOI: 10.16680/j.1671-3826.2022.07.18.
    [17]
    Society of Infectious Diseases, Chinese Medical Association. Expert consensus on diagnosis and treatment of end-stage liver disease complicated with infections(2021 version)[J]. J Clin Hepatol, 2022, 38( 2): 304- 310. DOI: 10.3969/j.issn.1001-5256.2022.02.010.

    中华医学会感染病学分会. 终末期肝病合并感染诊治专家共识(2021年版)[J]. 临床肝胆病杂志, 2022, 38( 2): 304- 310. DOI: 10.3969/j.issn.1001-5256.2022.02.010.
    [18]
    WANG XB, ZHANG Q, GAO FY. Prediction of acute-on-chronic liver failure and integrated traditional Chinese and Western medicine therapy[J]. J Clin Hepatol, 2020, 36( 1): 19- 25. DOI: 10.3969/j.issn.1001-5256.2020.01.003.

    王宪波, 张群, 高方媛. 慢加急性肝衰竭的预后评估及中西医结合治疗[J]. 临床肝胆病杂志, 2020, 36( 1): 19- 25. DOI: 10.3969/j.issn.1001-5256.2020.01.003.
    [19]
    HAINES RW, ZOLFAGHARI P, WAN Y, et al. Elevated urea-to-creatinine ratio provides a biochemical signature of muscle catabolism and persistent critical illness after major trauma[J]. Intensive care medicine, 2019, 45( 12): 1718- 1731. DOI: 10.1007/s00134-019-05760-5.
    [20]
    PAGE A, FLOWER L, PROWLE J, et al. Novel methods to identify and measure catabolism[J]. Curr Opin Crit Care, 2021, 27( 4): 361- 366. DOI: 10.1097/MCC.0000000000000842.
    [21]
    VERHAMME FM, FREEMAN CM, BRUSSELLE GG, et al. GDF-15 in pulmonary and critical care medicine[J]. Am J Respir Cell Mol Biol, 2019, 60( 6): 621- 628. DOI: 10.1165/rcmb.2018-0379TR.
    [22]
    LEE ES, KIM SH, KIM HJ, et al. Growth differentiation factor 15 predicts chronic liver disease severity[J]. Gut Liver, 2017, 11( 2): 276- 282. DOI: 10.5009/gnl16049.
    [23]
    ZHANG IW, CURTO A, LÓPEZ-VICARIO C, et al. Mitochondrial dysfunction governs immunometabolism in leukocytes of patients with acute-on-chronic liver failure[J]. J Hepatol, 2022, 76( 1): 93- 106. DOI: 10.1016/j.jhep.2021.08.009.
    [24]
    WEINERT LS, CAMARGO EG, SOARES AA, et al. Glomerular filtration rate estimation: Performance of serum cystatin C-based prediction equations[J]. Clin Chem Lab Med, 2011, 49( 11): 1761- 1771. DOI: 10.1515/CCLM.2011.670.
    [25]
    EINHORN D, MENDE CW. Combining creatinine-based EGFR with cystatin C-based EGFR to better assess renal function in patients with diabetes and chronic kidney disease 3a: Implications for drug selection and dosage in type 2 diabetes[J]. Endocr Pract, 2015, 21( 11): 1301- 1302. DOI: 10.4158/EP15821.ED.
    [26]
    CHEN XY, SHEN YJ, HOU LS, et al. Sarcopenia index based on serum creatinine and cystatin C predicts the risk of postoperative complications following hip fracture surgery in older adults[J]. BMC Geriatr, 2021, 21( 1): 541. DOI: 10.1186/s12877-021-02522-1.
    [27]
    ULMANN G, KAÏ J, DURAND JP, et al. Creatinine-to-cystatin C ratio and bioelectrical impedance analysis for the assessement of low lean body mass in cancer patients: Comparison to L3-computed tomography scan[J]. Nutrition, 2021, 81: 110895. DOI: 10.1016/j.nut.2020.110895.
    [28]
    ZHENG C, WANG E, LI JS, et al. Serum creatinine/cystatin C ratio as a screening tool for sarcopenia and prognostic indicator for patients with esophageal cancer[J]. BMC Geriatr, 2022, 22( 1): 207. DOI: 10.1186/s12877-022-02925-8.
    [29]
    SUN J, YANG H, CAI WT, et al. Serum creatinine/cystatin C ratio as a surrogate marker for sarcopenia in patients with gastric cancer[J]. BMC Gastroenterol, 2022, 22( 1): 26. DOI: 10.1186/s12876-022-02093-4.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(2)  / Tables(6)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (358) PDF downloads(50) Cited by()
    Proportional views
    Related
        

    The first journal specializing in hepatobiliary and pancreatic diseases in China

    Supervisor：Ministry of Education of the People's Republic of China

    Sponsor：Jilin University

    Academic Support: Chinese Society of Hepatology，Chinese Medical Association

    Address: 461 Xinjiang Road, Changchun

    Submit：0431-88782044

    Peer review：0431-88783542

    Email：lcgdb@vip.163.com

    About Journal

    Submission Guideline

    Journal Online

    Hepatobiliary College

    Guidelines

    YesterdayIP[]YesterdayPV[]TodayIP[]TodayPV[]Online[]

    Website Design © 2020 Editorial Board of Journal of Clinical Hepatology 吉ICP备10000617号-1 Supported by: Beijing Renhe Information Technology Co. Ltd  

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return