| Literature DB >> 30810244 |
Patricia Huelin1,2,3,4, Elsa Solà1,2,3,4, Chiara Elia1,2,3, Cristina Solé1,2,3, Alessandro Risso1,2,3, Rebeca Moreira1,2,3, Marta Carol1,2,3,4, Núria Fabrellas2,3,4, Octavi Bassegoda1,2, Adrià Juanola1,2, Gloria de Prada1,2,3, Sonia Albertos1,2,3, Salvatore Piano1,2,3, Isabel Graupera1,2,3, Xavier Ariza1,2,3, Laura Napoleone1,2,3, Elisa Pose1,2,3, Xavier Filella5, Manuel Morales-Ruiz2,3,4,5, José Rios6,7, Javier Fernández1,2,3,4, Wladimiro Jiménez2,3,4,5, Esteban Poch2,4,8, Ferran Torres6,7, Pere Ginès1,2,3,4.
Abstract
Kidney biomarkers appear to be useful in differential diagnosis between acute tubular necrosis (ATN) and other types of acute kidney injury (AKI) in cirrhosis, particularly hepatorenal syndrome (HRS-AKI). Distinction is important because treatment is different. However, kidney biomarkers are still not used in clinical practice. The aim of the current study was to investigate the accuracy of several biomarkers in differential diagnosis of AKI and in predicting kidney outcome and patient survival. This was a prospective study of 320 consecutive cases of AKI in patients hospitalized for decompensated cirrhosis. Evaluation of AKI was made with a diagnostic algorithm that included identification and removal/treatment of precipitating factors and albumin administration (1 g/kg for 2 days) to patients with AKI stage 1B or greater. Urinary neutrophil gelatinase-associated lipocalin (NGAL), monomeric NGAL (mNGAL), interleukin-18, and standard biomarkers were measured at diagnosis and on days 3, 7, and 14. Of the 320 cases, 153 were hypovolemia-induced AKI (48%), 93 were HRS-AKI (29%), 39 were ATN (12%), and 35 were due to miscellaneous causes (11%). Among all biomarkers, urinary NGAL measured at day 3 had the greatest accuracy for differential diagnosis between ATN and other types of AKI (area under the receiver operating characteristic curve, 0.87; 95% confidence interval, 0.78-0.95). The cutoff with the best predictive accuracy for ATN diagnosis was 220 µg/g creatinine. Progression of AKI during hospitalization was associated with persistently high NGAL levels, and NGAL was an independent predictive factor of AKI progression. Likewise, NGAL was also an independent predictive factor of 28-day mortality together with Model for End-Stage Liver Disease score.Entities:
Year: 2019 PMID： 30810244 DOI： 10.1002/hep.30592
Source DB: PubMed Journal: Hepatology ISSN： 0270-9139 Impact factor: 17.425