Urine neutrophil gelatinase-associated lipocalin: a diagnostic and prognostic marker for acute kidney injury (AKI) in hospitalized cirrhotic patients with AKI-prone conditions

Abstract

BackgroundAcute kidney injury (AKI) is known to increase mortality in hospitalized cirrhotic patients; therefore early identification is utmost significance. There are only a few studies evaluating the cut-off level of urine neutrophil gelatinase-associated lipocalin (uNGAL) for diagnosing AKI and its prognostic value in cirrhotic patients. We aimed to determine the accuracy of uNGAL as a biomarker for early identification of AKI and to determine the cut-off level of uNGAL for diagnosing AKI in hospitalized cirrhotic patients; and (2) to explore the association of 30-day liver-related mortality with uNGAL level.Methods and MaterialWe prospectively enrolled cirrhotic patients admitted at the King Chulalongkorn Memorial Hospital during May 1, 2011 to Dec 31, 2013. UNGAL levels were measured within 24 h after admission. Clinical and laboratory data were obtained. Patients were followed up to 30 days.ResultsOf 137 cirrhotic hospitalized patients, 121 cirrhotic patients (88.3 %) with AKI-prone conditions were included with mean age of 57.3 ± 14.7 years. Thirty-five patients (29 %) developed AKI within 72 h of admission. The causes of AKI were prerenal azotemia (68.6 %), acute tubular necrosis (25.7 %), hepatorenal syndrome (5.7 %), respectively. The mean uNGAL level was significantly higher in the patients who developed AKI compared with those who did not (290.6 ± 356.3 vs. 54.4 ± 73.7 ng/mL; P = 0.0001). The AUC of uNGAL for diagnosing AKI was 0.83 (95 % [CI]: 0.76–0.91) with the optimal cut-off level of 56 ng/mL, providing 77.1 % sensitivity and 73.3 % specificity. Fourteen percent of subjects died during the 30-day follow-up period. The mean uNGAL levels were significantly higher in the mortality group. The AUC of uNGAL in predicting mortality was 0.75 (95 % [CI]: 0.66–0.85), with a best cut-off level of 72 ng/mL providing 70.6 % sensitivity and 69.2 % specificity. However, in multivariate logistic regression analysis, uNGAL is not an independent factor for 30-day liver-related mortality prediction.ConclusionsuNGAL is a valid marker for the early detection of AKI in hospitalized cirrhotic patients with AKI-prone conditions; however, its level could not independently predict 30-day liver-related mortality.

Urinary Neutrophil Gelatinase Associated Lipocalin as a Biomarker for Diagnosis and Prognosis of Acute Kidney Injury (AKI) in Cirrhotic Patients

“…These results were similar to the study done by Ariza et al who studied 12 different novel biomarkers among patients with liver cirrhosis and impaired kidney function and found that uNGAL was the best for differentiation between the different aetiologies of AKI in cirrhosis [24] . Also this agreed with Treeprasertsuk et al who studied uNGAL prospectively in patients with liver cirrhosis with normal creatinine and had AKI prone conditions [25] .…”

“…while a cutoff value of 57 ng/ml showed sensitivity (63.3%) and specificity (90%) for prediction of poor prognosis (patients required dialysis, reported short term mortality or the need for ICU admission). Treeprasertsuk et al validated a cut off value of uNGAL of 56 ng/ml for AKI diagnosis providing 77.1 % sensitivity, 73.3 % specificity, 54 % positive predictive value (PPV), 88.7 % negative predictive value (NPV) and a cutoff value of 136.8 ng/ml for diagnosis of ATN with a sensitivity (88.9%) and specificity (80.4%) [25] .…”

“…A number of them have shown that uNGAL levels are markedly increased in patients with ATN compared to those of patients with pre-renal azotemia and non-progressive CKD, suggesting that uNGAL may be used for the differential diagnosis of the cause of acute kidney injury [23,25] .…”

“…Another stated that uNGAL predicts the development of kidney injury in different clinical settings, and may also be helpful in the prediction of the need for dialysis and early mortality especially in cirrhotic patients [25][26][27] .…”

The role of novel biomarkers in childhood idiopathic nephrotic syndrome: a narrative review of published evidence

“…21 In fact, proteomic biomarkers constitute a potential armamentarium for enhancing the management of patients with renal diseases by enabling a more accurate and earlier detection. 22 Several novel biomarkers have recently been documented as diagnostic and prognostic tools in diseases such as pediatric acute kidney injury, [23][24][25][26][27][28][29][30][31][32][33][34][35][36] and urinary tract infection. [37][38][39][40][41][42][43] Similarly, the utility of biomarkers in childhood idiopathic nephrotic syndrome has been reported; [12][13][14][15][16][17][18][19][20] their application constitutes a noninvasive approach in diagnostic nephrology, as they can be used as diagnostic and prognostic tools in idiopathic nephrotic syndrome, as well as discriminatory tools in distinguishing SRNS from SSNS (Table 1).…”