Renal Doppler ultrasound and serum Cystatin C level as predictors of hepatorenal syndrome in patients with advanced liver cirrhosis and normal serum creatinine level

Background and objectives
Patients with advanced of liver cirrhosis are liable to many serious complications as hepatorenal syndrome (HRS). This study was performed to evaluate renal resistance index (RRI) and Cystatin C (Cyst C) as predictors of HRS.
Patients and methods
The included 100 adult patients with liver cirrhosis and ascites were divided into three groups; group I with HRS (30 patients), group II with normal serum creatinine and increased RRI (40 patients), and group III with normal serum creatinine and normal RRI (30 patients). International normalized ratio, total bilirubin, albumin, creatinine, and Cyst C were measured in all enrolled candidates. Also, abdominal ultrasound was done with duplex Doppler examination of the kidneys and RRI was calculated. Group II was randomly divided into subgroups IIA and IIB where group IIA were received prophylactic therapy against HRS and group IIB did not. Both subgroups were followed for 6 months to assess their outcome and possibility to develop HRS.
Results
Serum Cyst C and RRI were significantly higher in those with HRS in comparison with other enrolled patients. There were significant correlation between serum Cyst C with RRI and estimated glomerular filtration rate. Progression to HRS and death was frequently higher in those patients who did not receive prophylactic therapy against HRS. With multivariate regression analysis; low serum albumin, increased RRI, and increased Cyst C are independent risk factors for progression to HRS while prophylactic therapy is protective against HRS in patients advanced liver cirrhosis.
Conclusion
Cyst C and RRI may be used as predictors for HRS in patients with advanced liver cirrhosis while prophylactic therapy may protect against HRS.