Urine albumin-to-creatinine ratio is associated with the severity of liver disease, renal function and survival in patients with decompensated cirrhosis

To investigate if urine albumin-to-creatinine ratio (UACR) is associated with the presence of glomerular filtration rate (GFR) < 60 mL/min, severity of liver disease and survival in patients with stable decompensated cirrhosis. We evaluated prospectively 220 patients (73 % male, age 52.8 +/- 12 years). In each patient, assessment of GFR was based on (51)chromium-EDTA. Random urine samples were obtained for measurement of UACR. Thirty-eight patients (17 %, group 1) had UACR 30 mg/g and 182 (83 %, group 2) had UACR < 30 mg/g. Group 1, compared to group 2 patients, had significantly lower levels of "true" GFR (61 vs. 71 ml/min, p = 0.035). Patients with "true" GFR < 60 mL/min (n = 93), compared to those with "true" GFR 60 mL/min (n = 127), had higher levels of UACR (16 vs. 11.3 mg/g, p = 0.023). In multivariate analysis, serum creatinine and UACR (IYR 0.98, 95 % CI 0.95-0.99, p = 0.04) were independently associated with the presence of GFR < 60 mL/min. Based on the area under the ROC curves, the best cut-off point for UACR was > 16.51 mg/g giving a sensitivity 70 %, specificity 49 %, PPV 68 % and NPV 51 %. During the follow-up period [17 (6-52) months], the patients who died or underwent LT (n = 158), compared to those who remained alive (n = 62), had higher levels of UACR (41 vs. 13 mg/g, p = 0.025). Patients with UACR 30 mg/g had worse outcome, compared to those with UACR < 30 mg/g (log rank p = 0.053). We showed for the first time that UACR 30 mg/g was associated with more severe liver disease, lower GFR and worse LT-free survival in patients with decompensated cirrhosis. However, further studies are needed to confirm these findings.