European Journal of Cardiovascular Medicine

Introduction: Acute kidney injury frequently occurs secondary to diuretics, intravenous radio contrast agents, paracentesis, gastrointestinal bleeding or infection and the development of Hepatorenal Syndrome (HRS) secondary to the progression of Liver Cirrhosis and elevation of portal pressure is not uncommon in the patients with Liver Cirrhosis. In several studies of AKI in such patients, those with serum Creatinine (Cr) levels of more than 1.3 to 1.5mg/mL have a poor prognosis. In early stages of HRS its possible to recover or delay deterioration of renal function with aggressive treatment . Though  Serum Creatinine is most widely used for measurement of GFR in clinical practice, it is greatly influenced by non renal factors, such as muscle atrophy and protein intake, especially in patients with Liver Cirrhosis. This study focusses on such scenarios where Cystatin C as a Novel Biomarker is superior to serum creatinine in predicting the incidence of Hepatorenal Syndrome in liver cirrhosis patients. Material and Methods: This is a Descriptive study was included about 100 patients diagnosed with Liver Cirrhosis in the Department of General Medicine at Mahatma Gandhi Medical College and Research Institute from July 2021 to December 2022. Detailed history, detailed clinical examination, complete blood count, liver function test, serum Cystatin C, Serum Urea, Creatinine, USG Abdomen, CT Abdomen if necessary, Endoscopy, Portal Venous Doppler. Results: Most of the patients in this study belong to the age group between 41 to 50 years (29 out of 100 patients). Patients belonging to age group between 31-40 are equally high. In this study, Males were more commonly affected when compared to female patients (88% were males & 12 % female patients.).  Out of the 100 patients in the study population, 24 patients developed Hepatorenal syndrome ( 19 belonged to Type 1 HRS & 5 belonged to  type 2 HRS). The Novel Biomarker Serum Cystatin C was Elevated in 92 % of the patients and was in the high normal limit in the remaining . On the other hand almost 97 % of patients had Normal serum Creatinine levels when it was done initially, only 3 % had  raised Creatinine level.  24 patients had increased Serum Creatinine levels only when followed up. Comparison between Cystatin C and Serum Creatinine in HRS patients showed a statistical significant P Value of < 0.001. The Sensitivity of Cystatin was 92 % and specificity was 80% in the Hepatorenal Syndrome Patients. Conclusion: Serum Cystatin C as a novel biomarker is a good predictor of Hepatorenal Syndrome (in early stages) in Liver Cirrhosis patients. It is superior to serum Creatinine in prediciting renal injury earlier in Liver Cirrhosis patients than serum Creatinine which varies with age, sex and with body mass etc. This study shows Cystatin C is more specific and sensitive marker of renal function in Liver Cirrhosis patients.