Neutrophil Gelatinase-Associated Lipocalin for Assessment of Acute Kidney Injury in Cirrhosis: A Prospective Study

Patricia Huelin, Elsa Solà, Chiara Elia, Cristina Solé, Alessandro Risso, Rebeca Moreira, Marta Carol, Núria Fabrellas, Octavi Bassegoda, Adrià Juanola, Gloria de Prada, Sonia Albertos, Salvatore Piano, Isabel Graupera, Xavier Ariza, Laura Napoleone, Elisa Pose, Xavier Filella, Manuel Morales-Ruiz, José RiosJavier Fernández, Wladimiro Jiménez, Esteban Poch, Pere Ginès, Ferran Torres

Research output: Contribution to journalArticleResearchpeer-review

33 Citations (Scopus)

Abstract

Kidney biomarkers appear to be useful in differential diagnosis between acute tubular necrosis (ATN) and other types of acute kidney injury (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. The 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. This was a prospective study of 320 consecutive cases of AKI in patients hospitalized for decompensated cirrhosis. Evaluation of AKI was made with a diagnostic algorithm that included identification and removal/treatment of precipitating factors and albumin administration (1 g/kg for 2 days) to patients with AKI stage 1B or greater. Urinary neutrophil gelatinase-associated lipocalin (NGAL), monomeric NGAL (mNGAL), interleukin-18, and standard biomarkers were measured at diagnosis and on days 3, 7, and 14. Of the 320 cases, 153 were hypovolemia-induced AKI (48%), 93 were HRS-AKI (29%), 39 were ATN (12%), and 35 were due to 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 (area under the receiver operating characteristic curve, 0.87; 95% confidence interval, 0.78-0.95). The cutoff with the best predictive accuracy for ATN diagnosis was 220 mu g/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 Model for End-Stage Liver Disease 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.

Original languageEnglish
Pages (from-to)319-333
Number of pages15
JournalHepatology
Volume70
Issue number1
DOIs
Publication statusPublished - 1 Jul 2019

Keywords

  • AKI
  • BIOMARKERS
  • DIFFERENTIAL-DIAGNOSIS
  • EVENTS
  • HEPATORENAL-SYNDROME
  • HOSPITALIZED-PATIENTS
  • IMPAIRMENT
  • MANAGEMENT
  • MORTALITY
  • SYMPATHETIC-NERVOUS-SYSTEM

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