TY - JOUR
T1 - Urinary NGAL as a Diagnostic and Prognostic Marker for Acute Kidney Injury in Cirrhosis
T2 - A Prospective Study
AU - Allegretti, Andrew S.
AU - Parada, Xavier Vela
AU - Endres, Paul
AU - Zhao, Sophia
AU - Krinsky, Scott
AU - St. Hillien, Shelsea A.
AU - Kalim, Sahir
AU - Nigwekar, Sagar U.
AU - Flood, James G.
AU - Nixon, Andrea
AU - Simonetto, Douglas A.
AU - Juncos, Luis A.
AU - Karakala, Nithin
AU - Wadei, Hani M.
AU - Regner, Kevin R.
AU - Belcher, Justin M.
AU - Nadim, Mitra K.
AU - Garcia-Tsao, Guadalupe
AU - Velez, Juan Carlos Q.
AU - Parikh, Samir M.
AU - Chung, Raymond T.
N1 - Funding Information:
Financial support: A.S.A. was supported by American Heart Association Award 18CDA34110131.
Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/5/11
Y1 - 2021/5/11
N2 - 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 g/g creatinine, NGAL distinguished ATN (344 [132, 1,429] g/g creatinine) from prerenal AKI (45 [0, 154] g/g) or HRS (110 [50, 393] g/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] g/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.
AB - 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 g/g creatinine, NGAL distinguished ATN (344 [132, 1,429] g/g creatinine) from prerenal AKI (45 [0, 154] g/g) or HRS (110 [50, 393] g/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] g/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.
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U2 - 10.14309/ctg.0000000000000359
DO - 10.14309/ctg.0000000000000359
M3 - Article
C2 - 33979307
AN - SCOPUS:85105838703
SN - 2155-384X
VL - 12
SP - E00359
JO - Clinical and Translational Gastroenterology
JF - Clinical and Translational Gastroenterology
IS - 5
ER -