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Urinary Neutrophil Gelatinase-Associated Lipocalin Predicts Mortality and Identifies Acute Kidney Injury in Cirrhosis

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Abstract

Background

Kidney failure predicts mortality in patients with cirrhosis. Identification of kidney failure etiology and recognition of those at the highest mortality risk remains a challenge.

Aims

We hypothesized that urinary neutrophil gelatinase-associated lipocalin (uNGAL) predicts mortality and identifies hepatorenal syndrome (HRS) in patients with cirrhosis.

Methods

Prospectively enrolled patients with cirrhosis were investigated by uNGAL immunoblot upon hospital admission. Kidney failure type was determined blinded to NGAL measurements.

Results

One hundred eighteen patients were enrolled. Fifty-two (44 %) patients had normal kidney function, 14 (12 %) stable chronic kidney disease, 17 (14 %) prerenal azotemia, 20 (17 %) HRS, and 15 (13 %) intrinsic acute kidney injury (iAKI). Patients with HRS had uNGAL levels intermediate between prerenal azotemia [median (IQR) 105 (27.5–387.5) vs. 20 (15–45) ng/mL, p = 0.004] and iAKI [325 (100–700), p < 0.001]. Fifteen (13 %) patients died. In unadjusted analysis, uNGAL predicted inpatient mortality (OR 2.00, 95 % CI 1.36–2.94) and mortality or liver transplantation (OR 2.01, 95 % CI 1.42–2.85). In multiple regression models, uNGAL > 110 ng/mL (OR 6.05, 95 % CI 1.35–27.2) and HRS (OR 6.71, 95 % CI 1.76–25.5) independently predicted mortality, adjusting for age and serum creatinine >1.5 mg/dL.

Conclusions

uNGAL strongly predicts short-term inpatient mortality in both unadjusted and adjusted models. Patients with HRS may have uNGAL levels intermediate between those with prerenal azotemia and iAKI. Further studies are needed to determine if uNGAL can improve discrimination of HRS from other types of acute kidney injury and predict short- and long-term cirrhosis outcomes.

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Conflict of interest

Abbott Labs and Biosite Inverness have licensed NGAL from Columbia University for the detection of AKI and CKD.

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Authors and Affiliations

  1. Division of Digestive and Liver Diseases, Department of Medicine, Center for Liver Disease and Transplantation, Columbia University College of Physicians and Surgeons, 622 West 168th St, PH 20, New York, NY, 10032, USA

    Elizabeth C. Verna, Robert S. Brown, Erica Farrand, Elsa M. Pichardo & Sarah H. Adkins

  2. Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA

    Catherine S. Forster, David A. Sola-Del Valle, Meghan E. Sise, Juan A. Oliver, Jai Radhakrishnan, Jonathan M. Barasch & Thomas L. Nickolas

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  1. Elizabeth C. Verna
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  2. Robert S. Brown
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Correspondence to Elizabeth C. Verna.

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Verna, E.C., Brown, R.S., Farrand, E. et al. Urinary Neutrophil Gelatinase-Associated Lipocalin Predicts Mortality and Identifies Acute Kidney Injury in Cirrhosis. Dig Dis Sci 57, 2362–2370 (2012). https://doi.org/10.1007/s10620-012-2180-x

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  • DOI: https://doi.org/10.1007/s10620-012-2180-x

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