The efficacy of biomarkers in the diagnosis of acute kidney injury secondary to liver cirrhosis

Abstract

This study is to investigate the role of neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (CysC) and creatinine in the diagnosis of acute kidney injury (AKI) secondary to liver cirrhosis. A total of 825 patients (including 540 liver cirrhosis patients and 285 healthy controls) were enrolled. Liver cirrhosis patients were further subdivided into AKI secondary to liver cirrhosis group (AKI group, 210 patients) and simple liver cirrhosis group (LC group, 330 patients). Serum NGAL/urine NGAL (sNGAL/uNGAL), and serum creatinine (sCr) levels as well as estimated glomerular filtration rates were measured. The diagnostic performances of these indicators in AKI secondary to liver cirrhosis were evaluated. The levels of sNGAL, uNGAL, CysC and sCr in the AKI group were significantly higher than those of LC and healthy control groups. However, the eGFR and c-aGFR of AKI group were significantly lower. With the progression of AKI (AKI-S1→AKI-S2→AKI-S3), the levels of sNGAL, uNGAL, CysC and sCr increased gradually, while the levels of c-aGFR and eGFR decreased gradually. The sNGAL, uNGAL and CysC were positively correlated with sCr (r = 0.638, 0.635, and 0.650), but negatively correlated with c-aGFR (r = -0.617, -0.606 and -0.655). However, eGFR had a negative correlation with sCr (r = -0.711), but a positive correlation with c-aGFR (r = 0.736). ROC curve analysis showed that the area under the curve for uNGAL was the largest (0.976), followed by sNGAL (0.967). The diagnostic efficacy of uNGAL and sNGAL in AKI group were 0.907 and 0.870, and the risk degrees were OR = 54.524 and 5.115, respectively. NGAL might perform better than sCr and CysC in the diagnosis of AKI secondary to liver cirrhosis, while uNGAL might be a better indicator than sNGAL in AKI diagnosis.

Seeing and Sensing the Hepatorenal Syndrome (HRS): The Growing Role of Ultrasound-Based Techniques as Non-Invasive Tools for the Diagnosis of HRS

“…The proposed mechanism is that damaged renal tubular cells lead to the upregulation of NAGL expression [38]. Urine and serum NGAL are independent predictors of AKI, with a higher sensitivity and specificity of uNGAL [39]. Some older studies showed that urinary levels of NAGL are correlated with the degree of renal injury, the value being markedly increased in urinary tract infections and acute tubular necrosis (ATN) compared to those with prerenal azotemia due to renal depletion, hepatorenal syndrome, or chronic kidney disease [40].…”

Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis

“…These tests may help identify AKI earlier compared to sCr and are promising; however, they are not widely available, and none of them are specific [ 3 , 11 , 32 , 33 ]. The majority of the studies comparing ATN vs. other etiologies lack histological confirmation of ATN.…”

Cystatin C as A Prognostic Biomarker to Monitor Renal Function in Liver Cirrhosis: A Narrative Review

“…Evaluation of renal function is usually done by measuring serum Cr in order to assess the GFR [5]. However, in patients with cirrhosis, serum Cr measurements are often inaccurate and often lie within the normal range due to factors such as age, gender, inadequate nutrition, muscle atrophy, bilirubin levels, renal tubular secretion malignancy or liver disease [3,6,7].…”