Serum Cystatin C as a Predictor of Mortality among Elderly Egyptians with Liver Cirrhosis

Abstract

T here is a dramatic increase in the elderly population in the world. Aging is a major risk factor for most chronic diseases. Cirrhosis is the leading cause of liver-related death globally. Deaths due to cirrhosis are expected to triple by 2030. Accurate prognostic tools could help clinicians make better diagnoses and select effective therapies with less time, thus improving the prognosis of patients. Hepatic fibrosis markers are ideal for predicting Liver cirrhosis prognosis since they can be obtained by a simple and noninvasive way. Although the superior efficacy of CysC over Cr for assessing renal function in patients with liver cirrhosis is well proven by various studies, the efficacy of CysC in predicting the prognosis of these patients, especially among elderly age group, has not been fully identified. This thesis was conducted to assess the predictive accuracy of serum CysC level for mortality in elderly patients with liver cirrhosis and to compare the ability of scoring systems to predict mortality outcome among this population. It was a cohort study that included 60 elderly inpatients (60 years old and above) diagnosed with liver cirrhosis, both males and females admitted with decompensation to Ain Shams University Hospitals or New Cairo Hospital, in Cairo, Egypt, with a 1-year post-hospital discharge follow up period for mortality outcome. The study showed that the leading cause of underlying liver disease was chronic hepatitis C (38 patients, 63.3%). After the 1-year period of follow up, 35 % of patients died due to different liver- related causes. Regarding the main issue of the study, it showed a highly significant association between mortality and higher levels of CysC, and higher scores of Child, MELD and MELD Na scoring systems. Besides, it showed a positive correlation between CysC level and Child, MELD & MELD Na scores. The current study also showed a highly significant association between mortality and lower scores of MMSE. It also showed a significant difference between survivors and non survivors regarding ADL and IADL. Additionally, it showed a negative correlation between CysC level and MMSE score. Multivariate regression analysis of the current study results proved that CysC level > 1 mg/l, Albumin ≤ 2.6 g/dl & MELD score > 16 are statistically significant independent predictors of 1 year mortality.