Relationship of Cys-C,Hcy with postoperative overt hepatic encephalopathy in cirrhotic patients with esophagogastric variceal bleeding
Deng Weining
Zhou Ke
Li Jingyuan
Zhao Ying
Shen Xiaoyuan
Peng Xiangying
Lyu Yuan
Abstract：Objective To explore the relationship of cystatin C(Cys-C)and homocysteine(Hcy)with postoperative overt he-patic encephalopathy(OHE)in cirrhotic patients with esophagogastric variceal bleeding(EGVB)treated with transjugular intrahepatic portosystemic shunt(TIPS).Methods This study enrolled 132 cirrhotic patients with EGVB who underwent TIPS at Affiliated Baoji Hospital of Xi'an Medical University from January 2021 to January 2024.Patients were assigned to OHE(n=42)and non-OHE(n=90)groups based on the presence or absence of OHE during follow-up.Clinical data in-cluding age,gender,BMI,preoperative portal vein diameter,Model for End-Stage Liver Disease(MELD)score,Child-Pugh class for liver function,diabetes,hypertension,ascites degree,and levels of hemoglobin,platelets,albumin,Cys-C,and Hcy were collected.Receiver operating characteristic(ROC)curves were used to evaluate the predictive value of Cys-C and Hcy for OHE after TIPS in cirrhotic patients with EGVB.Multivariate logistic stepwise regression analysis was per-formed to identify influencing factors for post-TIPS OHE.Results Serum Cys-C and Hcy levels in the OHE group were significantly higher than those in the non-OHE group(P<0.05).The AUCs(95%CI)for predicting OHE using Cys-C,Hcy,and their combination were 0.743(0.693-0.788),0.809(0.764-0.854),and 0.937(0.887-0.987),respective-ly.The OHE group had significantly longer preoperative main portal vein diameter(P<0.05),higher MELD scores(P<0.05),and higher proportions of Child-Pugh class C(P<0.05),diabetes(P<0.05),and massive ascites(P<0.05)compared to the non-OHE group.Multivariate logistic regression identified MELD score≥12.46(OR=2.113,95%CI:1.279-3.490),Child-Pugh class C(OR=2.547,95%CI:1.231-5.271),Cys-C≥1.80 mg/L(OR=3.529,95%CI:1.870-6.659),and Hcy≥18.86 μmol/L(OR=3.777,95%CI:1.876-7.604)as independent risk factors for OHE(P<0.05).Conclusion Serum Cys-C and Hcy are closely associated with post-TIPS OHE in cirrhotic EGVB patients.Combined use of these biomarkers markedly promotes prediction accuracy.Specifically,Cys-C≥1.80 mg/L and Hcy≥18.86 μmol/L indicate a considerably increased risk of OHE.Additionally,MELD scores and Child-Pugh class are critical prognostic indicators.
Keywords：Cystatin CHomocysteineLiver cirrhosisEsophageal and gastric varicesBleeding
Publication Date：2025-01-20
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 54-60 )