Desmond Y H Yap1, Wai Kay Seto2, James Fung2, Siu Ho Chok3, See Ching Chan3, Gary C W Chan4, Man Fung Yuen2, Tak Mao Chan4. 1. Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong. Electronic address: desmondy@hku.hk. 2. Division of Gastroenterology and Hepatology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong. 3. Division of Liver Transplantation, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong. 4. Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
Abstract
BACKGROUND: Prediction of hepatorenal syndrome (HRS) remains difficult in advanced cirrhotic patients. AIMS: To evaluate use of serum and urine biomarkers to predict HRS. METHODS: We prospectively recruited Child's B or C cirrhotic patients with normal serum creatinine, and followed them for 12 weeks for the development of HRS. Serum Cystatin C (CysC), serum and urine Neutrophil Gelatinase-Associated Lipocalin (NGAL), serum and urine IL-18, serum N-acetyl-β-d glucosaminidase (NAG), urine kidney injury molecule-1 (KIM-1) and urine liver-type fatty acid binding protein (LFABP) were measured at recruitment (baseline), and their relationship with subsequent HRS investigated. RESULTS: 43 patients were included. 12 (27.9%) developed HRS at 7.3±5.1 weeks from baseline. Logistic regression analysis showed that baseline urinary NGAL and urinary KIM-1 were significantly associated with the development of HRS (RR 1.007, 95% CI 1.001-1.012, p=0.014; RR 1.973, 95% CI 1.002-3.886, p=0.049). The cut-off values for NGAL and KIM-1 to predict HRS were 18.72ng/mL and 1.499ng/mL respectively (AUCs 0.84, p=0.005; and 0.78, p=0.008). CONCLUSION: Urinary NGAL and KIM-1 could serve as biomarkers to predict HRS in advanced cirrhotic patients.
BACKGROUND: Prediction of hepatorenal syndrome (HRS) remains difficult in advanced cirrhotic patients. AIMS: To evaluate use of serum and urine biomarkers to predict HRS. METHODS: We prospectively recruited Child's B or C cirrhotic patients with normal serum creatinine, and followed them for 12 weeks for the development of HRS. Serum Cystatin C (CysC), serum and urine Neutrophil Gelatinase-Associated Lipocalin (NGAL), serum and urine IL-18, serum N-acetyl-β-d glucosaminidase (NAG), urine kidney injury molecule-1 (KIM-1) and urine liver-type fatty acid binding protein (LFABP) were measured at recruitment (baseline), and their relationship with subsequent HRS investigated. RESULTS: 43 patients were included. 12 (27.9%) developed HRS at 7.3±5.1 weeks from baseline. Logistic regression analysis showed that baseline urinary NGAL and urinary KIM-1 were significantly associated with the development of HRS (RR 1.007, 95% CI 1.001-1.012, p=0.014; RR 1.973, 95% CI 1.002-3.886, p=0.049). The cut-off values for NGAL and KIM-1 to predict HRS were 18.72ng/mL and 1.499ng/mL respectively (AUCs 0.84, p=0.005; and 0.78, p=0.008). CONCLUSION: Urinary NGAL and KIM-1 could serve as biomarkers to predict HRS in advanced cirrhotic patients.
Authors: Marta Pietrukaniec; Maciej Migacz; Agnieszka Żak-Gołąb; Magdalena Olszanecka-Glinianowicz; Jerzy Chudek; Jan Duława; Michał Holecki Journal: Ren Fail Date: 2020-11 Impact factor: 2.606