Ratio between estimated glomerular filtration rates of creatinine and cystatin C predicts overall survival in patients with hepatocellular carcinoma

Tamai, Youichi; Iwasa, Motoh; Kawasaki, Yukako; Yoshizawa, Naohiko; Ogura, Suguru; Sugimoto, Ryosuke; Yamamoto, Norio; Sugimoto, Kazushi; Hasegawa, Hiroshi; Takei, Yoshiyuki

doi:10.1111/hepr.13230

Cited by 17 publications

(19 citation statements)

References 27 publications

(34 reference statements)

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“…The decrease in muscle strength is significantly more rapid than the concomitant loss of muscle mass (37). Tamai et al (15) described that the eGFRcre/eGFRcys ratio could be a useful predictive marker for survival in patients with hepatocellular carcinoma. As the relationship between dGFR and grip strength was clarified in the present study, the relationship between dGFR and the prognosis of liver disease should be evaluated.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Cr-to-CysC ratio (Cr/CysC x100), the so-called sarcopenia index (SI), has been reported to be associated with a fair measure of muscle mass estimation among patients admitted in the intensive care unit and can modestly predict the time in hospital and 90-day mortality among patients who do not have acute kidney injury at the time of measurement (11). SI correlates with muscle volume in patients with critical illness (11,12), lung transplant candidates (13), patients with type 2 diabetes (14) and patients with hepatocellular carcinoma (15). Cr production is relatively constant when the muscle mass is stable.…”

Section: Indices Calculated By Serum Creatinine and Cystatin C As Prementioning

confidence: 99%

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Indices calculated by serum creatinine and cystatin C as predictors of liver damage, muscle strength and sarcopenia in liver disease

et al. 2020

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Serum creatinine (Cr)-based glomerular filtration rate (CrGFR) is overestimated in liver disease. The present study evaluated whether the difference in CrGFR and cystatin C (CysC) GFR (dGFR) is significant in liver disease. The Cr-to-CysC ratio and sarcopenia index (SI) have been reported to correlate with muscle volume. An estimated total body muscle mass with Cr, CysC and calculated body muscle mass (CBMM) has also been reported to correlate with muscle mass. The applicability of dGFR, SI and CBMM for liver disease were evaluated. A total of 313 patients with liver damage were evaluated for Child-Pugh score, albumin-bilirubin (ALBI) score, model for end-stage liver disease, fibrosis-4, Cr, CysC, Cr-based estimated GFR (CreGFR), CysCGFR and grip strength. Of the 313 patients, 199 were evaluated using cross-sectional computed tomography (CT) of the third lumbar vertebra to determine the skeletal muscle (SM) mass. dGFR, CBMM and SI were compared to liver damage, muscle strength and muscle mass. In the 313 patients, dGFR was correlated with age, ALBI and grip strength; CBMM was correlated with body mass index (BMI) and grip strength; and SI was correlated with BMI and grip strength. In patients evaluated with CT, the correlation coefficients for CBMM and SI with SM were 0.804 and 0.293, respectively. Thus, CBMM and SI were associated with sarcopenia. The relationship between dGFR and ALBI does not differ with different grades of CrGFR-based chronic kidney disease (CKD). dGFR is a marker of liver damage and muscle strength regardless of CKD. CBMM and SI are markers for sarcopenia in liver disease.

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Section: Discussionmentioning

confidence: 99%

Section: Indices Calculated By Serum Creatinine and Cystatin C As Prementioning

confidence: 99%

Indices calculated by serum creatinine and cystatin C as predictors of liver damage, muscle strength and sarcopenia in liver disease

et al. 2020

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“…Moreover, we did not evaluate clinical data reflecting skeletal muscle volume loss. A recent study reported that the ratio between serum creatinine and serum cystatin C can be used as a surrogate for skeletal muscle and the ratio between estimated glomerular filtration rates of creatinine and cystatin C was independent predictor of survival in patients with HCC . Prospective large‐scale studies to overcome the above‐mentioned limitations and interventional studies to prevent sarcopenia are needed to improve prognosis in patients with HCC receiving TACE.…”

Section: Discussionmentioning

confidence: 99%

Skeletal muscle volume loss during transarterial chemoembolization predicts poor prognosis in patients with hepatocellular carcinoma

Fujita

Takahashi

Hayashi

et al. 2019

Hepatology Research

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Aim Sarcopenia has a negative impact on the prognosis of patients with hepatocellular carcinoma (HCC). We investigated the significance of skeletal muscle volume and its changes in HCC patients receiving transarterial chemoembolization (TACE). Methods We retrospectively analyzed 179 HCC patients receiving TACE from 2006 to 2017. Skeletal mass index was calculated as the left–right sum of the major × minor axis of the psoas muscle at the third lumbar vertebra, divided by height squared (psoas muscle index [PMI]). Patients were classified into two groups (low and normal PMI) depending on an index <6.0 and <3.4 cm2/m2 for men and women, respectively. We assessed overall survival (OS) and TACE period (between the first TACE [Pre] and the time of TACE refractoriness [Post]). Changes in PMI per month during the TACE period (CPMI; (PMI [Pre] − PMI [Post]) / TACE period) were calculated as an index of progressive muscle atrophy. Results There were no significant differences in OS between groups with low and normal PMI at Pre. Multivariate analysis showed that CPMI was significantly associated with poor OS (hazard ratio, 1.884; P = 0.001). Patients with severe muscle atrophy (CPMI above the upper quartile) had a significantly lower OS than those with mild muscle atrophy (CPMI below the upper quartile). Compared with patients with mild muscle atrophy, patients with severe muscle atrophy had a significant loss of liver function reserves at Post. Conclusion Progressive loss of skeletal muscle volume is an important predictor of poor prognosis in HCC patients treated with TACE.

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“…SI was calculated as follows: Cr / CysC ×100. CBMM was calculated using Cr, CysC, and BW according to the original report . The CBMM was calculated as follows:…”

Section: Methodsmentioning

confidence: 99%

“…Recently, the sarcopenia index (SI): (serum creatinine [Cr] / serum cystatin C [CysC] × 100) was reported as a fair measure of muscle mass estimations among patients admitted to intensive care units, and it could modestly predict the hospitalization duration and 90‐day mortality rates among patients who did not have acute kidney injuries when the measurements were taken . SIs have been correlated with muscle volumes in patients with critical illnesses, lung transplant candidates, patients with type 2 diabetes, and patients with hepatocellular carcinomas . Additionally, a new calculated body muscle mass (CBMM) equation to estimate total body muscle mass using Cr and CysC levels was developed .…”

Section: Introductionmentioning

confidence: 99%

Calculated body muscle mass as a useful screening marker for low skeletal muscle mass and sarcopenia in chronic liver disease

Ichikawa

Miyaaki

Miuma

et al. 2020

Hepatology Research

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Aim Sarcopenia is a harmful condition in patients with chronic liver disease. However, the evaluation of body muscle mass requires expensive instrumentation. The sarcopenia index (SI): (creatinine / cystatin C × 100) has been reported to correlate with muscle volume. A calculated body muscle mass (CBMM) using creatinine, cystatin C, and bodyweight also correlates with muscle mass. We evaluated the applicability of using SIs and CBMMs as screening methods for sarcopenia. Methods Patients (n = 303) with liver damage were evaluated for creatinine, cystatin C, and grip strength (GS). All patients were evaluated using cross‐sectional computed tomography images of the third lumbar vertebrae to determine their skeletal muscle (SM) mass. CBMMs and SIs were compared with SMs, GSs, and sarcopenia. Results Correlation coefficients (R) between SMI (SM / height2 [m2]) and CBMM, and between GS and CBMM were 0.643 and 0.723, respectively. Factors contributing to low GSs; low SM indices; and sarcopenia were age and SM; sex, age, GS, SI, and CBMM indices; and sex, bodyweight, and CBMM, respectively, in the multivariate logistic analyses. Receiver operating characteristic curve analysis between sarcopenia and CBMM showed an area under the receiver operating characteristic curve of 0.78504 in women and 0.86067 in men. Cut‐off CBMM values for sarcopenia were 27.903 (sensitivity 0.73958) in women and 39.731 (sensitivity 0.7941) in men. Conclusions CBMMs and SIs are simple and minimally invasive screening methods in which low levels are indicative of sarcopenia in patients with liver disease.

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Ratio between estimated glomerular filtration rates of creatinine and cystatin C predicts overall survival in patients with hepatocellular carcinoma

Abstract: The Scre/Scys ratio is associated with muscle mass and liver function. Furthermore, the eGFRcre/eGFRcys ratio could serve as a useful predictive marker for survival of HCC.

Cited by 17 publications

References 27 publications

Indices calculated by serum creatinine and cystatin C as predictors of liver damage, muscle strength and sarcopenia in liver disease

Indices calculated by serum creatinine and cystatin C as predictors of liver damage, muscle strength and sarcopenia in liver disease

Skeletal muscle volume loss during transarterial chemoembolization predicts poor prognosis in patients with hepatocellular carcinoma

Calculated body muscle mass as a useful screening marker for low skeletal muscle mass and sarcopenia in chronic liver disease

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