Korean J Gastroenterol.  2019 Oct;74(4):212-218. 10.4166/kjg.2019.74.4.212.

Clinical Significance of Urinary Neutrophil Gelatinase-associated Lipocalin Levels in Defining the Various Etiologies of Acute Kidney Injury in Liver Cirrhosis Patients

Affiliations
  • 1Department of Internal Medicine, Hankook General Hospital, Cheongju, Korea.
  • 2Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea. mseileen80@gmail.com

Abstract

BACKGROUND/AIMS
A diagnosis of hepatorenal syndrome (HRS) is based on a differential evaluation of acute kidney injury (AKI), which may aggravate the clinical course. This study assessed the clinical significance of the urinary neutrophil gelatinase-associated lipocalin (u-NGAL) levels in a differential diagnosis of AKI in patients with liver cirrhosis (LC).
METHODS
Patients with LC who developed AKI were enrolled prospectively. Clinically, patients with AKI were classified into prerenal azotemia (PRA), HRS, and acute tubular necrosis (ATN) groups.
RESULTS
Fifty-five patients (male, 74.5%) with LC who exhibited AKI upon admission were enrolled; 28, 9, and 18 patients were included in the PRA, HRS, and ATN groups, respectively. The baseline model for end-stage liver disease (MELD) scores was similar in the subgroups. The median event creatinine level, measured at the time of the AKI diagnosis, was similar in the HRS and ATN subgroups. On the other hand, the median event u-NGAL level differed significantly between the three subgroups (PRA, HRS, and ATN: 37 vs. 134 vs. 2,625 ng/mL, p=0.003). In particular, the median u-NGAL level of the HRS group was clearly different from those of the PRA (p<0.001) and ATN (p<0.001) groups. Multivariable analysis revealed the natural logarithm of the u-NGAL level (hazard ratio [HR] 1.77, p=0.031) and the MELD score (HR 1.17, p=0.027) to be independent prognostic factors for in-hospital mortality in patients with LC and AKI.
CONCLUSIONS
The median u-NGAL level differentiated HRS from ATN and served as a clinical indicator of in-hospital mortality for patients with LC and AKI.

Keyword

Lipocalins; Acute kidney injury; Hepatorenal syndrome; Kidney tubular necrosis, acute; Liver cirrhosis

MeSH Terms

Acute Kidney Injury*
Azotemia
Creatinine
Diagnosis
Diagnosis, Differential
Hand
Hepatorenal Syndrome
Hospital Mortality
Humans
Kidney Tubular Necrosis, Acute
Lipocalins*
Liver Cirrhosis*
Liver Diseases
Liver*
Necrosis
Neutrophils*
Prospective Studies
Creatinine
Lipocalins

Figure

  • Fig. 1 Scatter plot of u-NGAL in the groups on a logarithm scale. The median level of each group is displayed as numbers and bars above and in between the scatter plot. The median levels of u-NGAL in the PRA and HRS groups were 3.6 and 4.9 Ln ng/mL, respectively. The median level of u-NGAL in the ATN group was 7.9 Ln ng/mL and was significantly higher than the levels of the other groups. u-NGAL, urinary neutrophil gelatinase-associated lipocalin; PRA, prerenal azotemia; HRS, hepatorenal syndrome; ATN, acute tubular necrosis; Ln, natural logarithm.

  • Fig. 2 Survival curves according to the cause of AKI. The median survival times in the PRA, HRS, and ATN groups were unavailable (range, 9.8–12.7), 0.2 (range, 0.1–1.3), and 1.2 (range, 0–3.4) months, respectively. PRA, prerenal azotemia; HRS, hepatorenal syndrome; ATN, acute tubular necrosis; AKI, acute kidney injury.

  • Fig. 3 Survival curves according to the u-NGAL levels on a logarithmic scale. The Ln u-NGAL level was ≤3.6, 3.6–4.9, 4.9–7, and ≥7 in ≤25% (Q1), 25–50% (Q2), 50–75% (Q3), and ≥75% (Q4), respectively. The median level in Q1, Q2, Q3, and Q4 was 0.3 (range 0.1–0.5), 1.2 (range 0–3.2), 0.4 (range, 0–1.9), and 0.4 (range, 0–1.8) months, respectively. Ln, natural logarithm; u-NGAL, urinary neutrophil gelatinase-associated lipocalin; Q, quartile.


Cited by  1 articles

A Novel Biomarker for the Acute Kidney Injury in the Cirrhotic Patients
Nae-Yun Heo
Korean J Gastroenterol. 2019;74(4):191-192.    doi: 10.4166/kjg.2019.74.4.191.


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