Unit of Internal Medicine and Hepatology, Department of Medicine , University of Padova , Padova , Italy.
Laboratory Medicine Unit, Department of Medicine , University of Padova , Padova , Italy.
Hepatology. 2023 May 1;77(5):1630-1638. doi: 10.1002/hep.32799. Epub 2023 Apr 17.
Acute kidney injury (AKI) commonly occurs in patients with decompensated cirrhosis. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) could help discriminate between different etiologies of AKI. The aim of this study was to investigate the use of uNGAL in (1) the differential diagnosis of AKI, (2) predicting the response to terlipressin and albumin in patients with hepatorenal syndrome-AKI (HRS-AKI), and (3) predicting in-hospital mortality in patients with AKI.
One hundred sixty-two consecutive patients with cirrhosis and AKI were included from 2015 to 2020 and followed until transplant, death, or 90 days. Standard urinary markers and uNGAL were measured. Data on treatment, type, and resolution of AKI were collected. Thirty-five patients (21.6%) had prerenal AKI, 64 (39.5%) HRS-AKI, 27 (16.7%) acute tubular necrosis-AKI (ATN-AKI), and 36 (22.2%) a mixed form of AKI. Mean values of uNGAL were significantly higher in ATN-AKI than in other types of AKI (1162 ng/ml [95% CI 423-2105 ng/ml] vs. 109 ng/ml [95% CI 52-192 ng/ml]; p < 0.001). uNGAL showed a high discrimination ability in predicting ATN-AKI (area under the receiver operating characteristic curve, 0.854; 95% CI 0.767-0.941; p < 0.001). The best-performing threshold was found to be 220 ng/ml (sensitivity, 89%; specificity, 78%). The same threshold was independently associated with a higher risk of nonresponse (adjusted OR [aOR], 6.17; 95% CI 1.41-27.03; p = 0.016). In multivariable analysis (adjusted for age, Model for End-Stage Liver Disease, acute-on-chronic liver failure, leukocytes, and type of AKI), uNGAL was an independent predictor of in-hospital mortality (aOR, 1.74; 95% CI 1.26-2.38; p = 0.001).
uNGAL is an adequate biomarker for making a differential diagnosis of AKI in cirrhosis and predicting the response to terlipressin and albumin in patients with HRS-AKI. In addition, it is an independent predictor of in-hospital mortality.
失代偿性肝硬化患者常发生急性肾损伤（AKI）。尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）有助于鉴别 AKI 的不同病因。本研究旨在探讨 uNGAL 在以下方面的应用：（1）AKI 的鉴别诊断；（2）预测肝肾综合征-AKI（HRS-AKI）患者对特利加压素和白蛋白的反应；（3）预测 AKI 患者的住院死亡率。
2015 年至 2020 年期间共纳入 162 例肝硬化合并 AKI 的连续患者，并随访至移植、死亡或 90 天。测量了标准尿标志物和 uNGAL。收集了 AKI 的治疗、类型和缓解数据。35 例（21.6%）为肾前性 AKI，64 例（39.5%）为 HRS-AKI，27 例（16.7%）为急性肾小管坏死-AKI（ATN-AKI），36 例（22.2%）为混合性 AKI。ATN-AKI 患者的 uNGAL 平均值明显高于其他类型的 AKI（1162ng/ml [95% CI 423-2105ng/ml] vs. 109ng/ml [95% CI 52-192ng/ml]；p<0.001）。uNGAL 在预测 ATN-AKI 方面具有很高的区分能力（受试者工作特征曲线下面积，0.854；95% CI 0.767-0.941；p<0.001）。发现最佳性能阈值为 220ng/ml（灵敏度，89%；特异性，78%）。相同的阈值与无反应的风险增加独立相关（调整后的比值比[aOR]，6.17；95% CI 1.41-27.03；p=0.016）。在多变量分析（调整年龄、终末期肝病模型、急性加重的慢性肝衰竭、白细胞和 AKI 类型）中，uNGAL 是住院死亡率的独立预测因子（aOR，1.74；95% CI 1.26-2.38；p=0.001）。
uNGAL 是肝硬化 AKI 鉴别诊断的有效生物标志物，可预测 HRS-AKI 患者对特利加压素和白蛋白的反应。此外，它还是住院死亡率的独立预测因子。
