HDCN Abstract:  ASN Annual Meeting -- San Diego  

Verna EC, Farrand E, Forster CS, et al.

Urinary Neutrophil Gelatinase Associated Lipocalin Distinguishes Type of Kidney Failure and Predicts Mortality in Patients with Cirrhosis.

ASN Annual Meeting -- San Diego
J Am Soc Nephrol (Nov) 20:355A 2009

Kidney failure (KF) is a strong predictor of mortality in patients with cirrhosis. uNGAL discriminates AKI from other types of KF but has not been studied in cirrhosis or hepatorenal syndrome(HRS). We hypothesized that uNGAL would discriminate AKI and predict mortality for inpatients with cirrhosis. 94 patients were enrolled, mean age 57(10) years, 60% male. Cirrhosis was due to hepatitis C (HCV,45%), alcohol(23%), HCV and alcohol(10%), cryptogenic(10%) and other(12%). uNGAL was significantly higher in patients with AKI compared to patients with PRA, CKD or normal kidney function.

111(200)*
Normal(n=36)AKI(n=10)HRS(n=10)PRA(n=25)CKD(n=12)
Serum Creatinine(mg/dl)0.8(0.2)*3.1(1.9)2.3(1.3)1.6(0.7)*1.5(0.4)*
GFR(ml/min)110(32)34(27)38(24)48(18)49(15)
uNG AL(g/g crt)37(74)*720(749)228(245)36(31)*
Inpatient Mortality(%)2.7506008.3
p<0.05 compared to AKI


uNGAL in patients with HRS trended to levels between PRA (p<0.05) and AKI (p=0.06). 13 patients died, 22 were admitted to the ICU, 17 had nephrology consultation and 10 required hemodialysis. uNGAL was significantly higher in patients who died in comparison to patients who did not die(416(649) g/gm v. 94(227)mg/dL,p=0.001). A uNGAL cutoff of 130 g/gm and scr of 2.2 mg/dL had a sensitivity of 46% and specificity of 96% to discriminate inpatient mortality.

Analysis of the area under the ROC curve for mortality was 0.79 for uNGAL and 0.81 for Scr. Logistic regression demonstrated that a 50 g/gm rise in uNGAL increased the odds of death by 11% (OR 1.11, 95% CI 1.01-1.21, p=0.03). The odds of death was 9-fold higher for patients with a uNGAL>130 g/gm (OR 9.2, 95% CI 2.6-33.0, p=0.001). These data suggest that patients with HRS may have underlying tubular dysfunction manifesting as a blunted uNGAL rise vs. patients with AKI and that uNGAL levels may predict mortality risk. Further studies are needed to determine the diagnostic utility of uNGAL in patients with decompensated cirrhosis.

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