Urine neutrophil gelatinase-associated lipocalin as a biomarker of acute kidney injury and prognosis in decompensated chronic liver disease: A prospective study

Abstract

Background Acute kidney injury (AKI) heralds deterioration in patients with decompensated chronic liver disease (DCLD). Serum creatinine (sCr), a component of the model for end-stage liver disease-sodium (MELD-Na) prognostic score, has limitations in patients with DCLD. We evaluated the prognostic role of urine neutrophil gelatinase-associated lipocalin (NGAL) in DCLD and its ability to sub-type AKI. Methods Total 147 consecutive patients hospitalized between June 2018 and June 2020 for complications of DCLD were evaluated. Urine NGAL was estimated and demographic, clinical and biochemical parameters recorded at baseline. Participants were followed up till the end of study period or mortality, whichever came earlier. Primary outcomes included all-cause mortality and time to death after index hospitalization. Secondary outcomes included the presence and type of AKI, need for intensive care unit (ICU) stay, length of ICU/hospital stay, in-hospital mortality, development of new-onset/recurrent AKI and recurrent hospitalization after index admission. Results Urine NGAL was highest in acute tubular necrosis (ATN), lowest in pre-renal azotemia (PRA) and intermediate in hepatorenal syndrome (HRS-AKI). Urine NGAL ( p = 0.0208) was superior to sCr ( p = 0.0388) and inferior to fractionated excretion of sodium (FENa) ( p = 0.0013) in stratifying AKI. A cut-off of 203.9 ng/mL discriminated between HRS and PRA with sensitivity 77.8% and specificity 68.7%. Urine NGAL correlated with MELD-Na score, need for ICU stay, in-hospital mortality and mortality at three and six months. Two-year survival was significantly lower in patients with urine NGAL > 205 ng/mL. Addition of log-urine-NGAL score did not improve predictive performance of MELD-Na. Conclusion Urine NGAL could identify AKI sub-types and correlated with short-term clinical outcomes, including mortality.

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.…”

Indian Journal of Gastroenterology - January–February 2023 Highlights

“…Early recognition and characterization of the type of acute kidney injury will aid management and reduction of morbidity. Yewale et al, from the SRM Institutes for Medical Science, Chennai, India, in a study of 147 patients with decompensated chronic liver disease, report that urine concentration of neutrophil gelatinase-associated lipocalin as a single measurement was superior to serum creatinine (but to fractional excretion of sodium) in discriminating between the types of acute kidney injury [5]. Further urine neutrophil gelatinase-associated lipocalin correlated with various parameters of morbidity, including need for intensive care unit stay, and also with mortality both in-hospital and at three and six months after discharge from hospital.…”