Tae Hyung Kim1, Yeon Seok Seo1, Seong Hee Kang2, Moon Young Kim2, Sang Gyune Kim3, Hyo Young Lee4,5, Jeong-Hoon Lee4, Young-Sun Lee1, Ji Hoon Kim1, Soung Won Jeong6, Jae Young Jang6, Ki Tae Suk7, Young Kul Jung1, Hyonggin An8, Hyung Joon Yim1, Young Seok Kim3, Soon Ho Um1. 1. Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea. 2. Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea. 3. Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea. 4. Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea. 5. Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea. 6. Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea. 7. Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea. 8. Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.
Abstract
BACKGROUND AND AIMS: This prospective observational study aimed to evaluate the best serum and urine markers to assess predictability for the prognosis of patients with decompensated cirrhosis. METHODS: Serum creatinine and cystatin C (CysC), and urinary N-acetyl-beta-D glucosaminidase (uNAG) and neutrophil gelatinase-associated lipocalin (uNGAL) levels were measured from hospitalized patients with decompensated cirrhosis. RESULTS: In total, 328 patients (mean age, 57.2 ± 12.0 years; 237 men) with decompensated cirrhosis were included. Alcoholic liver disease was the most frequent underlying liver disease (68.0%). Acute kidney injury (AKI) was concomitantly present in 41 patients (12.5%) at baseline. INR, serum creatinine and CysC levels, and uNAG and uNGAL levels were significantly higher in patients with AKI. During hospitalization, AKI had progressed in 37 patients (11.3%). In 287 patients without AKI, the incidence of AKI at 3, 6, 9 and 12 months was 15.4%, 22.2%, 28.6% and 32.5% respectively. On multivariate analysis, serum CysC and uNAG levels were independent predictors of AKI, and their optimal cut-off values were 1.055 mg/L and 23.1 U/g urinary Cr respectively. When patients were classified into three groups with these cut-off values of serum CysC and uNAG levels (group 1, both low; group 2, one of two high; and group 3, both high), progression of AKI during hospitalization (P = .001), incidence of AKI in patients without AKI at baseline (P = .001) and mortality rate (P < .001) differed significantly according to serum CysC and uNAG levels. CONCLUSION: Serum CysC and uNAG levels are useful prognostic markers for renal outcomes and mortality in patients with decompensated cirrhosis.
BACKGROUND AND AIMS: This prospective observational study aimed to evaluate the best serum and urine markers to assess predictability for the prognosis of patients with decompensated cirrhosis. METHODS: Serum creatinine and cystatin C (CysC), and urinary N-acetyl-beta-D glucosaminidase (uNAG) and neutrophil gelatinase-associated lipocalin (uNGAL) levels were measured from hospitalized patients with decompensated cirrhosis. RESULTS: In total, 328 patients (mean age, 57.2 ± 12.0 years; 237 men) with decompensated cirrhosis were included. Alcoholic liver disease was the most frequent underlying liver disease (68.0%). Acute kidney injury (AKI) was concomitantly present in 41 patients (12.5%) at baseline. INR, serum creatinine and CysC levels, and uNAG and uNGAL levels were significantly higher in patients with AKI. During hospitalization, AKI had progressed in 37 patients (11.3%). In 287 patients without AKI, the incidence of AKI at 3, 6, 9 and 12 months was 15.4%, 22.2%, 28.6% and 32.5% respectively. On multivariate analysis, serum CysC and uNAG levels were independent predictors of AKI, and their optimal cut-off values were 1.055 mg/L and 23.1 U/g urinary Cr respectively. When patients were classified into three groups with these cut-off values of serum CysC and uNAG levels (group 1, both low; group 2, one of two high; and group 3, both high), progression of AKI during hospitalization (P = .001), incidence of AKI in patients without AKI at baseline (P = .001) and mortality rate (P < .001) differed significantly according to serum CysC and uNAG levels. CONCLUSION: Serum CysC and uNAG levels are useful prognostic markers for renal outcomes and mortality in patients with decompensated cirrhosis.
Authors: Kapil Gupta; Abhishek Bhurwal; Cindy Law; Scott Ventre; Carlos D Minacapelli; Savan Kabaria; You Li; Christopher Tait; Carolyn Catalano; Vinod K Rustgi Journal: World J Gastroenterol Date: 2021-07-14 Impact factor: 5.742