Neutrophil gelatinase‐associated lipocalin for assessment of acute kidney injury in cirrhosis. A prospective study

Abstract

Background/Aims

Kidney biomarkers appear to be useful in differential diagnosis between Acute Tubular Necrosis (ATN) and other types of AKI in cirrhosis, particularly hepatorenal syndrome (HRS‐AKI). Distinction is important because treatment is different. However, kidney biomarkers are still not used in clinical practice. Aim of the current study was to investigate the accuracy of several biomarkers in differential diagnosis of AKI and in predicting kidney outcome and patient survival.

Methods

Prospective study of 320 consecutive cases of AKI in patients hospitalized for decompensated cirrhosis. Evaluation of AKI was made with a diagnostic algorithm which included identification and removal/treatment of precipitating factors and albumin administration (1g/kg for 2 days) to patients with AKI stage1B or greater. Urinary NGAL, monomeric‐NGAL (mNGAL), IL‐18, as well as standard biomarkers were measured at diagnosis and days 3,7,and 14.

Results

Of the 320 cases, 153 had hypovolemia‐induced AKI (48%), 93 HRS‐AKI (29%), 39 ATN (12%), and 35 miscellaneous causes (11%). Among all biomarkers, urinary NGAL measured at day 3 had the greatest accuracy for differential diagnosis between ATN and other types of AKI (AUROC: 0.87[95%CI:0.78‐0.95]). The cut‐off with the best predictive accuracy for ATN diagnosis was 220 μg/g creatinine. Progression of AKI during hospitalization was associated with persistently high NGAL levels and NGAL was an independent predictive factor of AKI progression. Likewise, NGAL was also an independent predictive factor of 28‐day mortality together with MELD score.

Conclusion

These results support the use of NGAL in clinical practice within the context of a diagnostic algorithm for differential diagnosis of AKI and outcome prediction in cirrhosis.

This article is protected by copyright. All rights reserved.

https://ift.tt/2T2jWXn