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01.09.2012 | Original Article

Urinary Neutrophil Gelatinase-Associated Lipocalin Predicts Mortality and Identifies Acute Kidney Injury in Cirrhosis

verfasst von: Elizabeth C. Verna, Robert S. Brown, Erica Farrand, Elsa M. Pichardo, Catherine S. Forster, David A. Sola-Del Valle, Sarah H. Adkins, Meghan E. Sise, Juan A. Oliver, Jai Radhakrishnan, Jonathan M. Barasch, Thomas L. Nickolas

Erschienen in: Digestive Diseases and Sciences | Ausgabe 9/2012

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Abstract

Background

Kidney failure predicts mortality in patients with cirrhosis. Identification of kidney failure etiology and recognition of those at the highest mortality risk remains a challenge.

Aims

We hypothesized that urinary neutrophil gelatinase-associated lipocalin (uNGAL) predicts mortality and identifies hepatorenal syndrome (HRS) in patients with cirrhosis.

Methods

Prospectively enrolled patients with cirrhosis were investigated by uNGAL immunoblot upon hospital admission. Kidney failure type was determined blinded to NGAL measurements.

Results

One hundred eighteen patients were enrolled. Fifty-two (44 %) patients had normal kidney function, 14 (12 %) stable chronic kidney disease, 17 (14 %) prerenal azotemia, 20 (17 %) HRS, and 15 (13 %) intrinsic acute kidney injury (iAKI). Patients with HRS had uNGAL levels intermediate between prerenal azotemia [median (IQR) 105 (27.5–387.5) vs. 20 (15–45) ng/mL, p = 0.004] and iAKI [325 (100–700), p < 0.001]. Fifteen (13 %) patients died. In unadjusted analysis, uNGAL predicted inpatient mortality (OR 2.00, 95 % CI 1.36–2.94) and mortality or liver transplantation (OR 2.01, 95 % CI 1.42–2.85). In multiple regression models, uNGAL > 110 ng/mL (OR 6.05, 95 % CI 1.35–27.2) and HRS (OR 6.71, 95 % CI 1.76–25.5) independently predicted mortality, adjusting for age and serum creatinine >1.5 mg/dL.

Conclusions

uNGAL strongly predicts short-term inpatient mortality in both unadjusted and adjusted models. Patients with HRS may have uNGAL levels intermediate between those with prerenal azotemia and iAKI. Further studies are needed to determine if uNGAL can improve discrimination of HRS from other types of acute kidney injury and predict short- and long-term cirrhosis outcomes.

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Titel: Urinary Neutrophil Gelatinase-Associated Lipocalin Predicts Mortality and Identifies Acute Kidney Injury in Cirrhosis
verfasst von: Elizabeth C. Verna
Robert S. Brown
Erica Farrand
Elsa M. Pichardo
Catherine S. Forster
David A. Sola-Del Valle
Sarah H. Adkins
Meghan E. Sise
Juan A. Oliver
Jai Radhakrishnan
Jonathan M. Barasch
Thomas L. Nickolas
Publikationsdatum: 01.09.2012
Verlag: Springer US
Erschienen in: Digestive Diseases and Sciences / Ausgabe 9/2012
Print ISSN: 0163-2116
Elektronische ISSN: 1573-2568
DOI: https://doi.org/10.1007/s10620-012-2180-x

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Urinary Neutrophil Gelatinase-Associated Lipocalin Predicts Mortality and Identifies Acute Kidney Injury in Cirrhosis