Assessment and prediction of acute kidney injury in patients with decompensated cirrhosis with serum cystatin C and urine N‐acetyl‐β‐D‐glucosaminidase

Kim, Tae Hyung; Lee, Yong Sang; Seo, Yeon Seok; Lee, Yoo Ra; Yim, Sun Young; Suh, Sang Jun; Jung, Young Kul; Kim, Ji Hoon; An, Heeyoung; Yim, Hyung Joon; Yeon, Jong Eun; Byun, Kwan Soo; Um, Soon Ho

doi:10.1111/jgh.14387

Cited by 22 publications

(25 citation statements)

References 39 publications

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“…Based on these findings, we created the three groups according to the serum cystatin C and urine NAG levels. The cut-offs were similar to those reported in a previous single-centre retrospective study, 28 This study has some limitations. First, as an observational study, the results were vulnerable to residual confounding and ascertainment bias.…”

Section: Clinical Impact Of Serum Cystatin C and Urine Nag Levels Bsupporting

confidence: 82%

“…However, we have demonstrated the efficacy of urine NAG in distinguishing phenotypes of AKI in previous studies. 28 Third, the AUROCs of renal biomarkers in this study were relatively low, and so the results of this study require validation in external series of patients. Fourth, the renal biomarkers were measured only at baseline and not serially.…”

Section: Clinical Impact Of Serum Cystatin C and Urine Nag Levels Bmentioning

confidence: 84%

“…This result was consistent with that of a previous single-centre retrospective study. 28 Although urine NGAL is a definite marker for renal tubular injury, its level significantly increases in urinary tract infection, sepsis and malignancy. 27,[32][33][34] Thus, its elevation could be related to various conditions, which commonly occurred in patients with cirrhosis.…”

Section: Clinical Impact Of Serum Cystatin C and Urine Nag Levels Bmentioning

confidence: 99%

“…27 Owing to its characteristics, its level effectively differentiates AKI phenotypes and predicts the prognosis of patients with decompensated cirrhosis. 28 Several studies demonstrated that a combination of several renal biomarkers can maximize their prognosis predictability for patients with cirrhosis, 20,24,28 but no studies have yet used a combination of these three markers. Therefore, in this multi-institute prospective study, we tried to demonstrate the associations be-…”

Section: Introductionmentioning

confidence: 99%

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Prognosis predictability of serum and urine renal markers in patients with decompensated cirrhosis: A multicentre prospective study

Kim

Seo

Kang

et al. 2020

Liver International

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Background and Aims This prospective observational study aimed to evaluate the best serum and urine markers to assess predictability for the prognosis of patients with decompensated cirrhosis. Methods Serum creatinine and cystatin C (CysC), and urinary N‐acetyl‐beta‐D glucosaminidase (uNAG) and neutrophil gelatinase‐associated lipocalin (uNGAL) levels were measured from hospitalized patients with decompensated cirrhosis. Results In total, 328 patients (mean age, 57.2 ± 12.0 years; 237 men) with decompensated cirrhosis were included. Alcoholic liver disease was the most frequent underlying liver disease (68.0%). Acute kidney injury (AKI) was concomitantly present in 41 patients (12.5%) at baseline. INR, serum creatinine and CysC levels, and uNAG and uNGAL levels were significantly higher in patients with AKI. During hospitalization, AKI had progressed in 37 patients (11.3%). In 287 patients without AKI, the incidence of AKI at 3, 6, 9 and 12 months was 15.4%, 22.2%, 28.6% and 32.5% respectively. On multivariate analysis, serum CysC and uNAG levels were independent predictors of AKI, and their optimal cut‐off values were 1.055 mg/L and 23.1 U/g urinary Cr respectively. When patients were classified into three groups with these cut‐off values of serum CysC and uNAG levels (group 1, both low; group 2, one of two high; and group 3, both high), progression of AKI during hospitalization (P = .001), incidence of AKI in patients without AKI at baseline (P = .001) and mortality rate (P < .001) differed significantly according to serum CysC and uNAG levels. Conclusion Serum CysC and uNAG levels are useful prognostic markers for renal outcomes and mortality in patients with decompensated cirrhosis.

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Section: Clinical Impact Of Serum Cystatin C and Urine Nag Levels Bsupporting

confidence: 82%

Section: Clinical Impact Of Serum Cystatin C and Urine Nag Levels Bmentioning

confidence: 84%

Section: Clinical Impact Of Serum Cystatin C and Urine Nag Levels Bmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prognosis predictability of serum and urine renal markers in patients with decompensated cirrhosis: A multicentre prospective study

Kim

Seo

Kang

et al. 2020

Liver International

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“…Several biomarkers, such as urine neutrophil gelatinase-associated lipocalin and serum cystatin C, have been proposed as potential early predictors of AKI in cirrhotic patients. 17 – 19 Nevertheless, these biomarkers are not yet widely available in clinical practice and there are still patients who are at high risk for AKI that may not be detected. Echocardiography is a simple and noninvasive clinical tool with the potential to identify patients who are at high risk for AKI.…”

Section: Introductionmentioning

confidence: 99%

Early echocardiographic signs of diastolic dysfunction predict acute kidney injury in cirrhotic patients

Wang

Tai³

et al. 2020

Journal of the Chinese Medical Association

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Background: Cardiovascular dysfunction in cirrhotic patients affects survival and the development of cirrhotic complications. We aimed to evaluate potential echocardiographic parameters to predict mortality and acute kidney injury (AKI) in cirrhotic patients. Methods: A total of 103 cirrhotic patients who underwent echocardiography between February 2009 and August 2016 in Taipei Veterans General Hospital were retrospectively enrolled. Cardiac function was evaluated using transthoracic two-dimensional echocardiography with tissue Doppler imaging. Cox hazard regression analysis was used for assessing predictors for 1-year mortality and AKI within 1 year. Results: Baseline echocardiographic parameters were similar between survivors (n = 92) and nonsurvivors (n = 11). Lower serum levels of albumin, as well as higher albumin-bilirubin (ALBI) scores, Child-Pugh scores, and model for end-stage liver disease scores were observed in nonsurvivors. Cox proportional hazard regression analysis revealed Child-Pugh score as the only predictor of 1-year mortality. Baseline serum creatinine (Cr) > 1.5 mg/dL, total bilirubin > 2 mg/dL, and a higher E/e′ ratio predict occurrence of AKI within 1 year. Among patients with serum Cr < 1.5 mg/dL, an increased atrial filling velocity and higher ALBI scores predict AKI occurrence within 1 year. Conclusion: Severity of underlying liver disease but not echocardiographic parameters predicts 1-year mortality in cirrhosis. Early echocardiographic signs of diastolic dysfunction and higher ALBI scores may predict development of AKI in cirrhotic patients with serum Cr < 1.5 mg/dL.

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Urinary neutrophil gelatinase-associated lipocalin: Acute kidney injury in liver cirrhosis

Mohan

Nagaraju

Rangaswamy

et al. 2021

Clinica Chimica Acta

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Assessment and prediction of acute kidney injury in patients with decompensated cirrhosis with serum cystatin C and urine N‐acetyl‐β‐D‐glucosaminidase

Abstract: Serum cystatin C and urine NAG levels are useful to differentiate types of AKI and are strong predictors for AKI development and mortality in patients with decompensated cirrhosis.

Cited by 22 publications

References 39 publications

Prognosis predictability of serum and urine renal markers in patients with decompensated cirrhosis: A multicentre prospective study

Prognosis predictability of serum and urine renal markers in patients with decompensated cirrhosis: A multicentre prospective study

Early echocardiographic signs of diastolic dysfunction predict acute kidney injury in cirrhotic patients

Urinary neutrophil gelatinase-associated lipocalin: Acute kidney injury in liver cirrhosis

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