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Article Type

Original Study

Abstract

Objective The aim of this study was to investigate the role of homocysteine (Hcy) in patients with hepatorenal syndrome (HRS). Background Hcy increases in cirrhosis than in noncirrhotic liver diseases. Hyperhomocysteinemia is correlated with the clinical course of liver disease and is characteristically detected at late stages of cirrhosis. Patients and methods A total of 78 patients and 20 controls were divided into four groups. Group 1 included 28 cirrhotic patients without ascites. Group 2 included 25 cirrhotic patients with ascites. Group 3 included 25 patients with HRS. Group 4 included 20 healthy participants as a control group. Liver and kidney function tests, complete blood count, viral marker analysis, evaluation of serum Hcy using enzyme-linked immunosorbent assay, and renal duplex ultrasonography were carried out. Results Patients with liver cirrhosis showed significantly higher serum Hcy levels in comparison with controls. Positive correlations were found between Hcy and age, child classification, model for end-stage liver disease score, creatinine level, and renal resistive index (RRI), whereas serum Hcy was negatively correlated with creatinine clearance. Hcy at a cutoff value of more than 17 micromol/l could predict patients with HRS with 89% sensitivity and 80% specificity.RRI at cutoff value of more than 0.75 could predict patients with HRS with 85% sensitivity and 80% specificity. The sensitivity was 94%, and accuracy was 87%, when Hcy and RRI were estimated together in patients with HRS. Conclusion Hcy can be considered as a predictive marker for patients with HRS.

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