Role of FIB-4 and eGFRcysC as Diagnostic Tools for Early Detection of Impaired Hepato-Renal Function in Chronic Alcoholics
Keywords:
Chronic alcohol use, Cystatin C, eGFR, FIB-4 index, Hepatic fibrosisAbstract
Aim: To evaluate the association between hepatic fibrosis, measured by the Fibrosis-4 (FIB-4) index, and renal function, assessed by cystatin C–based estimated glomerular filtration rate (eGFRcysC), in chronic alcohol-consuming patients, and to compare findings with age- and sex-matched healthy controls.
Methods: Cross-sectional, case–control research was done at the Department of Biochemistry, Subharti Medical College, Meerut, between 18 months. One hundred chronic alcoholics (≥10 years; >40 g/day for males and >20 g/day for females) and 100 healthy controls were enrolled. Exclusion conditions were non-alcoholic liver disease, severe chronic kidney disease (CKD), nephrotoxic drugs, malignancy, HIV, acute sepsis, and pregnancy. Clinical information was captured and fasting blood draws assayed for liver and renal function, viral markers, and serum cystatin C. FIB-4 scores and eGFRcysC were determined. Statistical analysis was done with Student's t-test and Chi-square test with p<0.05 as significant.
Results:Patients had much higher mean FIB-4 values (3.37 ± 1.40 vs 1.13 ± 0.42, p<0.001) and lower eGFRcysC (24.82 ± 7.56 vs 91.47 ± 14.98 mL/min/1.73 m², p<0.001) than controls. Cystatin C was increased in patients (2.84 ± 0.70 vs 0.96 ± 0.11 mg/L, p<0.001). Increased grades of fibrosis correlated with higher CKD stages, and there was a very strong inverse correlation between FIB-4 and eGFRcysC.
Conclusion: Chronic alcohol use is associated with concurrent hepatic fibrosis and renal impairment. FIB-4 and eGFRcysC are accessible, reliable, and complementary tools for early detection of hepatorenal dysfunction, with potential to guide timely interventions in at-risk populations.
Downloads
Metrics
References
O'Shea RS, Dasarathy S, McCullough AJ. Alcoholic liver disease. Hepatology. 2010;51(1):307–328.
Nanau RM, Neuman MG. Alcohol and the Kidney. J Pharm Pharm Sci. 2015;18(1):177–192.
Vallet-Pichard A, Mallet V, Nalpas B, et al. FIB-4: An inexpensive and accurate marker of fibrosis in HCV infection. Hepatology. 2007;46(1):32–36.
Liu Z, Que S, Zhou L, Zheng S. Dose-response relationship between alcohol consumption and the risk of liver fibrosis. J Hepatol. 2014;60(2):448–456.
Grubb A, Horio M, Hansson LO, et al. Generation of a new cystatin C–based estimating equation for GFR assessment. Clin Chem. 2014;60(7):974–986.
Shah AG, Lydecker A, Murray K, Tetri BN, Contos MJ, Sanyal AJ. Comparison of non-invasive markers for liver fibrosis in NAFLD. Clin Gastroenterol Hepatol. 2009;7(10):1104–1112.
Choudhary NS, Saraf N, Puri AS, et al. Validation of FIB-4 in Alcoholic Liver Disease: A North Indian Cohort. J Clin Exp Hepatol. 2023;13(1):27–33.
KDIGO 2021 Clinical Practice Guideline for the Evaluation and Management of CKD. Kidney Int. 2021;99(3S):S1–S115.
Roca D, Esquivel-Valerio JA, Cantu-Brito C, et al. eGFR based on cystatin C as a predictor of AKI in cirrhotics. Nephrol Dial Transplant. 2022;37(1):110–117.
Park HJ, Seo YS, Yim HJ, et al. Combined Use of FIB-4 and eGFRcysC Predicts Outcomes in Alcoholic Cirrhosis. Clin Mol Hepatol. 2021;27(3):376–386.
Zhou W, Li Y, Zhang M, et al. Prognostic value of cystatin C–based eGFR in liver disease: A meta-analysis. BMC Nephrol. 2023;24:37.
Knight EL, Verhave JC, Spiegelman D, et al. Factors influencing serum cystatin C levels other than renal function and the impact on renal function measurement. Kidney Int. 2004;65(4):1416–1421.
Shen H, Li Y, Wang J, et al. Artificial Intelligence in Liver and Renal Function Prediction: Future Directions. Front Med (Lausanne). 2023;10:1173210.
Lieber CS. Metabolism of alcohol. Clin Liver Dis. 2005;9(1):1–35.
Setshedi M, Wands JR, De la Monte SM. Acetaldehyde adducts in alcoholic liver disease. Oxid Med Cell Longev. 2010;3(3):178–85.
Szabo G, Bala S. Alcoholic liver disease and the gut-liver axis. World J Gastroenterol. 2010;16(11):1321–9.
Shukla SD, Lim RW. Epigenetic effects of ethanol on the liver and gastrointestinal system. Alcohol Res. 2013;35(1):47–55.
Gao B, Bataller R. Alcoholic liver disease: pathogenesis and new therapeutic targets. Gastroenterology. 2011;141(5):1572–85.
Proulx NL, Akdamar K, Steinberg KP. Kidney dysfunction in alcoholic liver disease. J Clin Gastroenterol. 2006;40 Suppl 1:S46–52.
Singbartl K, Kellum JA. AKI in the ICU: definition, epidemiology, risk stratification, and outcomes. Kidney Int. 2012;81(9):819–25.
Wong F. Management of hepatorenal syndrome in patients with cirrhosis. Nat Rev Nephrol. 2012;8(5):241–9.
Ku E, Lee BJ, Wei J, Weir MR. Hypertension in CKD: Core Curriculum 2019. Am J Kidney Dis. 2019;74(1):120–131.
Ginès P, Schrier RW. Renal failure in cirrhosis. N Engl J Med. 2009;361(13):1279–90.
Nickolas TL, Schmidt-Ott KM, Canetta P, et al. Diagnostic and prognostic stratification in the emergency department using urinary biomarkers of nephron damage. J Am Coll Cardiol. 2012;59(3):246–55.
Umbro I, Baratta F, Angelico F, Del Ben M. Nonalcoholic fatty liver disease and the kidney: a review. Biomedicines. 2021 Oct 1;9(10):1370.
Fernandez M, Trépo E, Degré D, Gustot T, Verset L, Demetter P, Devière J, Adler M, Moreno C. Transient elastography using Fibroscan is the most reliable noninvasive method for the diagnosis of advanced fibrosis and cirrhosis in alcoholic liver disease. European Journal of Gastroenterology & Hepatology. 2015 Sep 1;27(9):1074-9.
El-Makarem MA, Mousa MM, Ayaad LA, Keryakos HK. Comparative study of various glomerular filtration rate estimating equations in Egyptian patients with hepatitis C virus-related liver cirrhosis: a single-center observational study. Egyptian Liver Journal. 2021 Mar 30;11(1):23.
Kuma A, Mafune K, Uchino B, Ochiai Y, Miyamoto T, Kato A. Potential link between high FIB-4 score and chronic kidney disease in metabolically healthy men. Scientific Reports. 2022 Oct 5;12(1):16638.
Xin G, Li Q, Sheng C, Zha Y, Cheng K. Comparation of two cystatin C-based eGFR equations in assessing risk of all-cause mortality and incident cardiovascular disease. Nutrition & Metabolism. 2024 Nov 19;21(1):94.
Zhu Z Y, et al. Fibrosis 4 index as a predictor of all cause and cardiovascular mortality in patients with chronic kidney disease. PLoS One. 2025;20(8)
Krones E, Fickert P, Zitta S, Neunherz S, Artinger K, Reibnegger G, Durchschein F, Wagner D, Stojakovic T, Stadlbauer V, Fauler G. The chronic kidney disease epidemiology collaboration equation combining creatinine and cystatin C accurately assesses renal function in patients with cirrhosis. BMC nephrology. 2015 Dec 1;16(1):196.
Wang D, Feng JF, Wang AQ, Yang YW, Liu YS. Role of Cystatin C and glomerular filtration rate in diagnosis of kidney impairment in hepatic cirrhosis patients. Medicine. 2017 May 1;96(20):e6949.
Downloads
Published
How to Cite
Issue
Section
License

This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.