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 Rios; Javier Fernández; Wladimiro Jiménez; Esteban Poch; Pere Ginès; Ferran Torres

doi:10.1002/hep.30592

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

Department of Paediatrics, Obstetrics and Gynaecology, and Preventive Medicine and Public Health

Research output: Contribution to journal › Article › Research › peer-review

150 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 language	English
Pages (from-to)	319-333
Number of pages	15
Journal	Hepatology
Volume	70
Issue number	1
DOIs	https://doi.org/10.1002/hep.30592
Publication status	Published - 1 Jul 2019

Keywords

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

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10.1002/hep.30592

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Huelin, P., Solà, E., Elia, C., Solé, C., Risso, A., Moreira, R., Carol, M., Fabrellas, N., Bassegoda, O., Juanola, A., de Prada, G., Albertos, S., Piano, S., Graupera, I., Ariza, X., Napoleone, L., Pose, E., Filella, X., Morales-Ruiz, M., ... Torres, F. (2019). Neutrophil Gelatinase-Associated Lipocalin for Assessment of Acute Kidney Injury in Cirrhosis: A Prospective Study. Hepatology, 70(1), 319-333. https://doi.org/10.1002/hep.30592

@article{296483541c184454a3ec27a44b3b7903,

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

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.",

keywords = "AKI, BIOMARKERS, DIFFERENTIAL-DIAGNOSIS, EVENTS, HEPATORENAL-SYNDROME, HOSPITALIZED-PATIENTS, IMPAIRMENT, MANAGEMENT, MORTALITY, SYMPATHETIC-NERVOUS-SYSTEM",

author = "Patricia Huelin and Elsa Sol{\`a} and Chiara Elia and Cristina Sol{\'e} and Alessandro Risso and Rebeca Moreira and Marta Carol and N{\'u}ria Fabrellas and Octavi Bassegoda and Adri{\`a} Juanola and \{de Prada\}, Gloria and Sonia Albertos and Salvatore Piano and Isabel Graupera and Xavier Ariza and Laura Napoleone and Elisa Pose and Xavier Filella and Manuel Morales-Ruiz and Jos{\'e} Rios and Javier Fern{\'a}ndez and Wladimiro Jim{\'e}nez and Esteban Poch and Pere Gin{\`e}s and Ferran Torres",

year = "2019",

month = jul,

day = "1",

doi = "10.1002/hep.30592",

language = "English",

volume = "70",

pages = "319--333",

journal = "Hepatology",

issn = "0270-9139",

publisher = "Lippincott Williams and Wilkins",

number = "1",

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Huelin, P, Solà, E, Elia, C, Solé, C, Risso, A, Moreira, R, Carol, M, Fabrellas, N, Bassegoda, O, Juanola, A, de Prada, G, Albertos, S, Piano, S, Graupera, I, Ariza, X, Napoleone, L, Pose, E, Filella, X, Morales-Ruiz, M, Rios, J, Fernández, J, Jiménez, W, Poch, E, Ginès, P & Torres, F 2019, 'Neutrophil Gelatinase-Associated Lipocalin for Assessment of Acute Kidney Injury in Cirrhosis: A Prospective Study', Hepatology, vol. 70, no. 1, pp. 319-333. https://doi.org/10.1002/hep.30592

TY - JOUR

T1 - Neutrophil Gelatinase-Associated Lipocalin for Assessment of Acute Kidney Injury in Cirrhosis: A Prospective Study

AU - Huelin, Patricia

AU - Solà, Elsa

AU - Elia, Chiara

AU - Solé, Cristina

AU - Risso, Alessandro

AU - Moreira, Rebeca

AU - Carol, Marta

AU - Fabrellas, Núria

AU - Bassegoda, Octavi

AU - Juanola, Adrià

AU - de Prada, Gloria

AU - Albertos, Sonia

AU - Piano, Salvatore

AU - Graupera, Isabel

AU - Ariza, Xavier

AU - Napoleone, Laura

AU - Pose, Elisa

AU - Filella, Xavier

AU - Morales-Ruiz, Manuel

AU - Rios, José

AU - Fernández, Javier

AU - Jiménez, Wladimiro

AU - Poch, Esteban

AU - Ginès, Pere

AU - Torres, Ferran

PY - 2019/7/1

Y1 - 2019/7/1

N2 - 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.

AB - 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.

KW - AKI

KW - BIOMARKERS

KW - DIFFERENTIAL-DIAGNOSIS

KW - EVENTS

KW - HEPATORENAL-SYNDROME

KW - HOSPITALIZED-PATIENTS

KW - IMPAIRMENT

KW - MANAGEMENT

KW - MORTALITY

KW - SYMPATHETIC-NERVOUS-SYSTEM

U2 - 10.1002/hep.30592

DO - 10.1002/hep.30592

M3 - Article

C2 - 30810244

SN - 0270-9139

VL - 70

SP - 319

EP - 333

JO - Hepatology

JF - Hepatology

IS - 1

ER -

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

Abstract

Keywords

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