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Glomerular filtration rate is an independent factor of mortality in patients with decompensated cirrhosis
Author(s) -
Cholongitas Evangelos,
Arsos George,
Goulis John,
Birtsou Charis,
Haidich AnnaBettina,
Nakouti Theodora,
Chalevas Parthenis,
Ioannidou Maria,
Karakatsanis Konstantinos,
Akriviadis Evangelos
Publication year - 2014
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/hepr.12259
Subject(s) - medicine , renal function , creatinine , cirrhosis , gastroenterology , hazard ratio , hepatorenal syndrome , cohort , cystatin c , confidence interval , kidney disease , urology , surgery
Aim Although serum creatinine is included in the M odel for E nd‐ S tage L iver D isease ( MELD ) score, it is an inaccurate marker of renal function, namely, of glomerular filtration rate (“true” GFR ) in patients with decompensated cirrhosis. Our aim was to investigate the impact of MELD score and “true” GFR as determinants of survival in patients with decompensated cirrhosis. Methods We included all consecutive patients with decompensated cirrhosis who were admitted to our department. Renal function was assessed by creatinine‐ and cystatin‐based estimated GFR and “true” GFR using 51 Cr ‐ethylenediaminetetraacetic acid. The independent factors associated with survival were evaluated. The discriminative ability of the prognostic scores ( MELD and modifications of MELD score) were evaluated by using the area under the receiver–operator curve ( AUC ). Results One hundred and ten consecutive patients (77 men, aged 56 ± 12 years); at the end of follow up (8 months; range, 6–18), 92 patients (84%) were alive and 18 (16%) had died. In multivariate analysis, serum bilirubin (hazard ratio [ HR ], 1.15; 95% confidence interval [ CI ], 1.05–1.26; P = 0.020) and “true” GFR ( HR , 0.96; 95% CI , 0.93–0.98; P = 0.003) were the only independent factors significantly associated with the outcome. The derived new prognostic model had high discriminative ability ( AUC , 0.90), which was confirmed in the validation sample of 77 patients. Conclusion In our cohort of patients with decompensated cirrhosis, “true” GFR and bilirubin were the independent factors of the outcome.