The development of acute‐on‐chronic liver failure (ACLF) in patients with liver cirrhosis is associated with high mortality rates. Renal failure is the most significant organ dysfunction that occurs in ACLF. So far there are no biomarkers predicting ACLF. We investigated whether cystatin C (CysC) and neutrophil gelatinase‐associated lipocalin (NGAL) can predict development of renal dysfunction (RD), hepatorenal syndrome (HRS), ACLF, and mortality. We determined the plasma levels of CysC and NGAL in 429 patients hospitalized for acute decompensation of cirrhosis in the EASL‐CLIF Acute‐on‐Chronic Liver Failure in Cirrhosis (CANONIC) study. The patients were followed for 90 days. Patients without RD or ACLF at inclusion but with development of either had significantly higher baseline concentrations of CysC and NGAL compared to patients without. CysC, but not NGAL, was found to be predictive of RD (odds ratio, 9.4; 95% confidence interval [CI], 1.8‐49.7), HRS (odds ratio, 4.2; 95% CI, 1.2‐14.8), and ACLF (odds ratio, 5.9; 95% CI, 1.3‐25.9). CysC at day 3 was not found to be a better predictor than baseline CysC. CysC and NGAL were both predictive of 90‐day mortality, with hazard ratios for CysC of 3.1 (95% CI, 2.1‐4.7) and for NGAL of 1.9 (95% CI, 1.5‐2.4). Conclusion: Baseline CysC is a biomarker of RD, HRS, and ACLF and an independent predictor of mortality in patients with acutely decompensated liver cirrhosis, though determining CysC at day 3 did not provide any benefit; while NGAL is also associated with short‐term mortality, it fails to predict development of RD, HRS, and ACLF. Baseline CysC may help to identify patients at risk earlier and improve clinical management. (Hepatology 2017;66:1232‐1241)

中文翻译：

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血浆胱抑素 C 是急性失代偿性肝硬化患者肾功能障碍、ACLF 和死亡率的预测因子

肝硬化患者发生急性加慢性肝衰竭（ACLF）与高死亡率相关。肾功能衰竭是 ACLF 中发生的最重要的器官功能障碍。到目前为止，还没有预测 ACLF 的生物标志物。我们研究了胱抑素 C (CysC) 和中性粒细胞明胶酶相关脂质运载蛋白 (NGAL) 是否可以预测肾功能障碍 (RD)、肝肾综合征 (HRS)、ACLF 和死亡率的发展。在 EASL-CLIF 慢性肝硬化急性肝衰竭 (CANONIC) 研究中，我们测定了 429 名因肝硬化急性失代偿住院的患者的 CysC 和 NGAL 血浆水平。对患者进行了 90 天的随访。与无 RD 或 ACLF 的患者相比，纳入时没有 RD 或 ACLF 但有任何一种的患者具有显着更高的 CysC 和 NGAL 基线浓度。半胱氨酸，但不是 NGAL，被发现可预测 RD（比值比，9.4；95% 置信区间 [CI]，1.8-49.7）、HRS（比值比，4.2；95% CI，1.2-14.8）和 ACLF（比值比比率，5.9；95% CI，1.3-25.9）。未发现第 3 天的 CysC 是比基线 CysC 更好的预测因子。CysC 和 NGAL 均可预测 90 天死亡率，CysC 的风险比为 3.1（95% CI，2.1-4.7），NGAL 的风险比为 1.9（95% CI，1.5-2.4）。结论：基线 CysC 是 RD、HRS 和 ACLF 的生物标志物，是急性失代偿性肝硬化患者死亡率的独立预测因子，尽管在第 3 天确定 CysC 并没有提供任何益处；虽然 NGAL 也与短期死亡率相关，但它无法预测 RD、HRS 和 ACLF 的发展。基线 CysC 可能有助于更早地识别有风险的患者并改善临床管理。（肝病学 2017；