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2015 ; 15
(ä): 140
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Urine neutrophil gelatinase-associated lipocalin: a diagnostic and prognostic
marker for acute kidney injury (AKI) in hospitalized cirrhotic patients with
AKI-prone conditions
#MMPMID26474856
Treeprasertsuk S
; Wongkarnjana A
; Jaruvongvanich V
; Sallapant S
; Tiranathanagul K
; Komolmit P
; Tangkijvanich P
BMC Gastroenterol
2015[Oct]; 15
(ä): 140
PMID26474856
show ga
BACKGROUND: Acute kidney injury (AKI) is known to increase mortality in
hospitalized cirrhotic patients; therefore early identification is utmost
significance. There are only a few studies evaluating the cut-off level of urine
neutrophil gelatinase-associated lipocalin (uNGAL) for diagnosing AKI and its
prognostic value in cirrhotic patients. We aimed to determine the accuracy of
uNGAL as a biomarker for early identification of AKI and to determine the cut-off
level of uNGAL for diagnosing AKI in hospitalized cirrhotic patients; and (2) to
explore the association of 30-day liver-related mortality with uNGAL level.
METHODS AND MATERIAL: We prospectively enrolled cirrhotic patients admitted at
the King Chulalongkorn Memorial Hospital during May 1, 2011 to Dec 31, 2013.
UNGAL levels were measured within 24 h after admission. Clinical and laboratory
data were obtained. Patients were followed up to 30 days. RESULTS: Of 137
cirrhotic hospitalized patients, 121 cirrhotic patients (88.3 %) with AKI-prone
conditions were included with mean age of 57.3?±?14.7 years. Thirty-five patients
(29 %) developed AKI within 72 h of admission. The causes of AKI were prerenal
azotemia (68.6 %), acute tubular necrosis (25.7 %), hepatorenal syndrome (5.7 %),
respectively. The mean uNGAL level was significantly higher in the patients who
developed AKI compared with those who did not (290.6?±?356.3 vs. 54.4?±?73.7
ng/mL; P?=?0.0001). The AUC of uNGAL for diagnosing AKI was 0.83 (95 % [CI]:
0.76-0.91) with the optimal cut-off level of 56 ng/mL, providing 77.1 %
sensitivity and 73.3 % specificity. Fourteen percent of subjects died during the
30-day follow-up period. The mean uNGAL levels were significantly higher in the
mortality group. The AUC of uNGAL in predicting mortality was 0.75 (95 % [CI]:
0.66-0.85), with a best cut-off level of 72 ng/mL providing 70.6 % sensitivity
and 69.2 % specificity. However, in multivariate logistic regression analysis,
uNGAL is not an independent factor for 30-day liver-related mortality prediction.
CONCLUSIONS: uNGAL is a valid marker for the early detection of AKI in
hospitalized cirrhotic patients with AKI-prone conditions; however, its level
could not independently predict 30-day liver-related mortality.