Treeprasertsuk Sombat, Wongkarnjana Amornpun, Jaruvongvanich Veeravich, Sallapant Sasipim, Tiranathanagul Khajohn, Komolmit Piyawat, Tangkijvanich Pisit
Division of Gastroenterology, Department of Medicine, Faculty of Medicine, and King Chulalongkorn Memorial Hospital, Chulalongkorn University, Rama4 Road, Pathumwan District, Bangkok, 10330, Thailand.
Division of Nephrology, Department of Medicine, Faculty of Medicine, and King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, 10330, Thailand.
BMC Gastroenterol. 2015 Oct 16;15:140. doi: 10.1186/s12876-015-0372-5.
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.
背景：急性肾损伤（AKI）已知会增加住院肝硬化患者的死亡率；因此早期识别至关重要。仅有少数研究评估尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）用于诊断肝硬化患者AKI的临界值及其预后价值。我们旨在确定uNGAL作为早期识别AKI生物标志物的准确性，并确定住院肝硬化患者诊断AKI的uNGAL临界值；以及（2）探讨30天肝脏相关死亡率与uNGAL水平的关联。 方法与材料：我们前瞻性纳入了2011年5月1日至2013年12月31日在朱拉隆功国王纪念医院住院的肝硬化患者。入院后24小时内测量uNGAL水平。获取临床和实验室数据。对患者进行30天随访。 结果：137例住院肝硬化患者中，121例（88.3%）有发生AKI倾向的患者被纳入，平均年龄为57.3±14.7岁。35例患者（29%）在入院72小时内发生AKI。AKI的病因分别为肾前性氮质血症（68.6%）、急性肾小管坏死（25.7%）、肝肾综合征（5.7%）。发生AKI的患者uNGAL平均水平显著高于未发生AKI的患者（290.6±356.3 vs. 54.4±73.7 ng/mL；P = 0.0001）。uNGAL诊断AKI的曲线下面积（AUC）为0.83（95%可信区间[CI]：0.76 - 0.91），最佳临界值为56 ng/mL，敏感性为77.1%，特异性为73.3%。14%的受试者在30天随访期内死亡。死亡组的uNGAL平均水平显著更高。uNGAL预测死亡率的AUC为0.75（95% CI：0.66 - 0.85），最佳临界值为72 ng/mL，敏感性为70.6%，特异性为69.2%。然而，在多因素逻辑回归分析中，uNGAL不是30天肝脏相关死亡率预测的独立因素。 结论：uNGAL是有发生AKI倾向的住院肝硬化患者早期检测AKI的有效标志物；然而，其水平不能独立预测30天肝脏相关死亡率。
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2011-8
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