Sex specificity of kidney markers to assess prognosis in cirrhotic patients with TIPS

Autor: Adjmal Mangal, Jennifer Lehmann, Maria Torner, Javier Fernández, Jonel Trebicka, Christian Jansen, Michael Praktiknjo, Wenyi Gu, Rainer P. Woitas, Frank Erhard Uschner, Christian P. Strassburg, Alexander Queck, Hubert Scharnagl, Robert Schierwagen, Christiana Graf, Tatjana Stojakovic
Rok vydání: 2019
Předmět:
Liver Cirrhosis
Male
Cirrhosis
medicine.medical_treatment
beta-trace protein
Liver transplantation
Severity of Illness Index
Gastroenterology
Cohort Studies
chemistry.chemical_compound
0302 clinical medicine
cystatin C
Germany
Aged
80 and over
biology
portal hypertension
Middle Aged
Prognosis
Lipocalins
Intramolecular Oxidoreductases
Creatinine
030220 oncology & carcinogenesis
Cohort
Portal hypertension
Female
Kidney Diseases
030211 gastroenterology & hepatology
Glomerular Filtration Rate
Adult
medicine.medical_specialty
Adolescent
Renal function
Young Adult
03 medical and health sciences
Sex Factors
Internal medicine
medicine
Humans
ddc:610
Cystatin C
Aged
Hepatology
business.industry
cirrhosis
renal function
medicine.disease
Survival Analysis
chemistry
Propensity score matching
biology.protein
Portasystemic Shunt
Transjugular Intrahepatic
business
Biomarkers
Zdroj: Liver International
Torner, M, Mangal, A, Scharnagl, H, Jansen, C, Praktiknjo, M, Queck, A, Gu, W, Schierwagen, R, Lehmann, J, Uschner, F E, Graf, C, Strassburg, C P, Fernandez, J, Stojakovic, T, Woitas, R & Trebicka, J 2020, ' Sex specificity of kidney markers to assess prognosis in cirrhotic patients with TIPS ', Liver International, vol. 40, no. 1, pp. 186-193 . https://doi.org/10.1111/liv.14230
ISSN: 1478-3231
1478-3223
DOI: 10.1111/liv.14230
Popis: 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.
Databáze: OpenAIRE
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