Faculty Collaboration Database

Urinary NGAL as a Diagnostic and Prognostic Marker for Acute Kidney Injury in Cirrhosis: A Prospective Study. Clin Transl Gastroenterol 2021 May 11;12(5):e00359

Date

05/13/2021

Pubmed ID

33979307

Pubmed Central ID

PMC8116001

DOI

10.14309/ctg.0000000000000359

Scopus ID

2-s2.0-85105838703 (requires institutional sign-in at Scopus site)   66 Citations

Abstract

INTRODUCTION: Urinary neutrophil gelatinase-associated lipocalin (NGAL) has shown promise in differentiating acute tubular necrosis (ATN) from other types of acute kidney injuries (AKIs) in cirrhosis, particularly hepatorenal syndrome (HRS). However, NGAL is not currently available in clinical practice in North America.

METHODS: Urinary NGAL was measured in a prospective cohort of 213 US hospitalized patients with decompensated cirrhosis (161 with AKI and 52 reference patients without AKI). NGAL was assessed for its ability to discriminate ATN from non-ATN AKI and to predict 90-day outcomes.

RESULTS: Among patients with AKI, 57 (35%) had prerenal AKI, 55 (34%) had HRS, and 49 (30%) had ATN, with a median serum creatinine of 2.0 (interquartile range 1.5, 3.0) mg/dL at enrollment. At an optimal cutpoint of 244 μg/g creatinine, NGAL distinguished ATN (344 [132, 1,429] μg/g creatinine) from prerenal AKI (45 [0, 154] μg/g) or HRS (110 [50, 393] μg/g; P < 0.001), with a C statistic of 0.762 (95% confidence interval 0.682, 0.842). By 90 days, 71 of 213 patients (33%) died. Higher median NGAL was associated with death (159 [50, 865] vs 58 [0, 191] μg/g; P < 0.001). In adjusted and unadjusted analysis, NGAL significantly predicted 90-day transplant-free survival (P < 0.05 for all Cox models) and outperformed Model for End-Stage Liver Disease score by C statistic (0.697 vs 0.686; P = 0.04), net reclassification index (37%; P = 0.008), and integrated discrimination increment (2.7%; P = 0.02).

DISCUSSION: NGAL differentiates the type of AKI in cirrhosis and may improve prediction of mortality; therefore, it holds potential to affect management of AKI in cirrhosis.

Author List

Allegretti AS, Parada XV, Endres P, Zhao S, Krinsky S, St Hillien SA, Kalim S, Nigwekar SU, Flood JG, Nixon A, Simonetto DA, Juncos LA, Karakala N, Wadei HM, Regner KR, Belcher JM, Nadim MK, Garcia-Tsao G, Velez JCQ, Parikh SM, Chung RT, HRS-HARMONY study investigators

Author

Kevin R. Regner MD Interim Chair, Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acute Kidney Injury
Biomarkers
Diagnosis, Differential
Female
Hepatorenal Syndrome
Humans
Kidney Tubular Necrosis, Acute
Lipocalin-2
Liver Cirrhosis
Male
Middle Aged
Prognosis
Prospective Studies
Reproducibility of Results
Survival Analysis
United States