Urinary Neutrophil Gelatinase Associated Lipocalin as a Biomarker for Diagnosis and Prognosis of Acute Kidney Injury (AKI) in Cirrhotic Patients
Journal Title: Journal of Medical Science And clinical Research - Year 2017, Vol 5, Issue 2
Abstract
Introduction: Acute kidney injury is associated with increased mortality in hospitalized cirrhotic patients; therefore early and accurate diagnosis is crucial. The prognosis of AKI in cirrhosis depends on its specific aetiology which remains a challenge. Aim: We aimed to determine the accuracy of urinary Neutrophil Gelatinase-Associated Lipocalin (uNGAL) for diagnosis, differentiation of the various aetiologies of AKI in cirrhotics and to evaluate its value in short term prognosis. Methods: Eighty-two cirrhotic patients were investigated for uNGAL during hospital admission and AKI types were determined blinded to uNGAL measurements. Patients were followed up till discharge. Results: Patients with liver cirrhosis and renal impairment (n= 62) had significantly higher levels of uNGAL (102.4 ±100 ng/ml) when compared with patients with cirrhotics with normal kidney function (n= 20) (102.4 ±100 vs 17.4±14.71 ng/ml). Patients with acute tubular necrosis (ATN) had significantly higher uNGAL (189.2±124 ng/ml) compared to other aetiologies, while prerenal azotemia had the lowest value (46.1±39.9 ng/ml). UNGAL levels were significantly higher in the mortality group of patients (p=0.006) and in patients admitted to ICU (p<0.001) than the survivors and patient without ICU admission respectively. The AUC of uNGAL for diagnosis of AKI was 0.892 with a cutoff > 33 ng/ml providing specificity 90% and sensitivity 79%. In multivariate regression analysis, uNGAL was highly significant independent predictor of inpatient cirrhosis relayed mortality. Conclusion: UNGAL is a promising biomarker for diagnosis of AKI and differentiation between its different aetiologies in cirrhosis including ATN, HRS and pre renal azotemia. UNGAL can independently predict poor short term prognosis.
Authors and Affiliations
Mona H. Elzohri
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