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. 2025 Jul 24;26(1):413.
doi: 10.1186/s12882-025-04341-7.

Cystatin C as a predictor of renal recovery and in hospital mortality in patients with acute kidney injury and liver cirrhosis

Eman Nagy  1 , Ahmed H Abdelfattah  2 , Nagy Sayed-Ahmed  3 , Sadiq Ahmed  4
Affiliations

Cystatin C as a predictor of renal recovery and in hospital mortality in patients with acute kidney injury and liver cirrhosis

Eman Nagy et al. BMC Nephrol. .

Abstract

Background: Acute kidney injury (AKI) is a common and serious complication in patients with liver cirrhosis, with pre-renal AKI and acute tubular necrosis being the most frequent underlying causes. Cystatin C is a non-glycosylated 13 kDa protein that is consistently produced by all nucleated cells and has been suggested as a potential predictor of mortality in this patient population. The role of cystatin C in predicting renal recovery in these patients is not known and this was the aim of our study.

Methods: This was a retrospective single center study that included hospitalized patients with liver cirrhosis who developed or were admitted with AKI and had serum cystatin C in their records from May 2017 to May 2023. The sociodemographic and laboratory data were retrieved from the data system. The in-hospital mortality, length of hospital stay, and renal recovery were recorded. Renal recovery was defined as a reduction in serum creatinine without needing dialysis on discharge.

Results: This study included 209 patients with AKI and liver cirrhosis. Sixty-five patients (31%) died during hospital admission. The renal recovery was shown in 136 patients (65%). White blood cells, serum albumin, and peak serum cystatin C were the significant predictors for in-hospital mortality (p = 0.021, 0.013, and 0.001, respectively). Hypertension, serum albumin, baseline creatinine and baseline cystatin C were significant predictors of renal recovery in the studied patients (p = 0.017, 0.006, 0.030, and < 0.001, respectively). The cut-off value of baseline serum cystatin C for prediction of renal recovery was 2.62 with moderate sensitivity and specificity.

Conclusion: In the current study, baseline serum cystatin C is a predictor of renal recovery in patients with AKI and liver cirrhosis. However, peak serum cystatin C is a predictor of mortality in these patients.

Keywords: AKI; Cystatin C; Liver cirrhosis; Mortality; Renal recovery.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was adhered to the Declaration of Helsinki and was approved by the University of Kentucky institutional review board (IRB number 86422, dated 7/6/2024. Informed consent was waived due to the retrospective nature of the study and the minimal risk to participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
ROC curve for predictors of mortality
Fig. 2
Fig. 2
ROC curve for predictors of renal recovery
See this image and copyright information in PMC

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