Urinary NGAL as a Diagnostic and Prognostic Marker for Acute Kidney Injury in Cirrhosis: A Prospective Study
Urinary neutrophil gelatinase-associated lipocalin (NGAL) has shown promise in differentiating acute tubular necrosis (ATN) from other types of acute kidney injuries (AKIs) in cirrhosis, particularly hepatorenal syndrome (HRS). However, NGAL is not currently available in clinical practice in North A...
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| Veröffentlicht in: | Clinical and translational gastroenterology 2021-05, Vol.12 (5), p.e00359-e00359 |
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| creator | Allegretti, Andrew S. Parada, Xavier Vela Endres, Paul Zhao, Sophia Krinsky, Scott St. Hillien, Shelsea A. Kalim, Sahir Nigwekar, Sagar U. Flood, James G. Nixon, Andrea Simonetto, Douglas A. Juncos, Luis A. Karakala, Nithin Wadei, Hani M. Regner, Kevin R. Belcher, Justin M. Nadim, Mitra K. Garcia-Tsao, Guadalupe Velez, Juan Carlos Q. Parikh, Samir M. Chung, Raymond T. |
| description | Urinary neutrophil gelatinase-associated lipocalin (NGAL) has shown promise in differentiating acute tubular necrosis (ATN) from other types of acute kidney injuries (AKIs) in cirrhosis, particularly hepatorenal syndrome (HRS). However, NGAL is not currently available in clinical practice in North America.
Urinary NGAL was measured in a prospective cohort of 213 US hospitalized patients with decompensated cirrhosis (161 with AKI and 52 reference patients without AKI). NGAL was assessed for its ability to discriminate ATN from non-ATN AKI and to predict 90-day outcomes.
Among patients with AKI, 57 (35%) had prerenal AKI, 55 (34%) had HRS, and 49 (30%) had ATN, with a median serum creatinine of 2.0 (interquartile range 1.5, 3.0) mg/dL at enrollment. At an optimal cutpoint of 244 μg/g creatinine, NGAL distinguished ATN (344 [132, 1,429] μg/g creatinine) from prerenal AKI (45 [0, 154] μg/g) or HRS (110 [50, 393] μg/g; P < 0.001), with a C statistic of 0.762 (95% confidence interval 0.682, 0.842). By 90 days, 71 of 213 patients (33%) died. Higher median NGAL was associated with death (159 [50, 865] vs 58 [0, 191] μg/g; P < 0.001). In adjusted and unadjusted analysis, NGAL significantly predicted 90-day transplant-free survival (P < 0.05 for all Cox models) and outperformed Model for End-Stage Liver Disease score by C statistic (0.697 vs 0.686; P = 0.04), net reclassification index (37%; P = 0.008), and integrated discrimination increment (2.7%; P = 0.02).
NGAL differentiates the type of AKI in cirrhosis and may improve prediction of mortality; therefore, it holds potential to affect management of AKI in cirrhosis. |
| doi_str_mv | 10.14309/ctg.0000000000000359 |
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Urinary NGAL was measured in a prospective cohort of 213 US hospitalized patients with decompensated cirrhosis (161 with AKI and 52 reference patients without AKI). NGAL was assessed for its ability to discriminate ATN from non-ATN AKI and to predict 90-day outcomes.
Among patients with AKI, 57 (35%) had prerenal AKI, 55 (34%) had HRS, and 49 (30%) had ATN, with a median serum creatinine of 2.0 (interquartile range 1.5, 3.0) mg/dL at enrollment. At an optimal cutpoint of 244 μg/g creatinine, NGAL distinguished ATN (344 [132, 1,429] μg/g creatinine) from prerenal AKI (45 [0, 154] μg/g) or HRS (110 [50, 393] μg/g; P < 0.001), with a C statistic of 0.762 (95% confidence interval 0.682, 0.842). By 90 days, 71 of 213 patients (33%) died. Higher median NGAL was associated with death (159 [50, 865] vs 58 [0, 191] μg/g; P < 0.001). In adjusted and unadjusted analysis, NGAL significantly predicted 90-day transplant-free survival (P < 0.05 for all Cox models) and outperformed Model for End-Stage Liver Disease score by C statistic (0.697 vs 0.686; P = 0.04), net reclassification index (37%; P = 0.008), and integrated discrimination increment (2.7%; P = 0.02).
NGAL differentiates the type of AKI in cirrhosis and may improve prediction of mortality; therefore, it holds potential to affect management of AKI in cirrhosis.</description><identifier>ISSN: 2155-384X</identifier><identifier>EISSN: 2155-384X</identifier><identifier>DOI: 10.14309/ctg.0000000000000359</identifier><identifier>PMID: 33979307</identifier><language>eng</language><publisher>United States: Wolters Kluwer</publisher><subject>Acute Kidney Injury - diagnosis ; Acute Kidney Injury - etiology ; Acute Kidney Injury - mortality ; Acute Kidney Injury - urine ; Ascites ; Biomarkers - urine ; Creatinine ; Diagnosis, Differential ; Female ; Hepatorenal Syndrome - diagnosis ; Hepatorenal Syndrome - urine ; Humans ; Kidney Tubular Necrosis, Acute - diagnosis ; Kidney Tubular Necrosis, Acute - urine ; Kidneys ; Lipocalin-2 - urine ; Liver ; Liver cirrhosis ; Liver Cirrhosis - complications ; Liver diseases ; Male ; Medical prognosis ; Middle Aged ; Mortality ; Prognosis ; Prospective Studies ; Reproducibility of Results ; Survival Analysis ; Transplants & implants ; United States - epidemiology</subject><ispartof>Clinical and translational gastroenterology, 2021-05, Vol.12 (5), p.e00359-e00359</ispartof><rights>Wolters Kluwer</rights><rights>Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.</rights><rights>2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4841-76d022cabdd86f291a07da2ec021c6a25d9e96d2aebac789749e3f54ac49b0133</citedby><cites>FETCH-LOGICAL-c4841-76d022cabdd86f291a07da2ec021c6a25d9e96d2aebac789749e3f54ac49b0133</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8116001/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8116001/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27903,27904,53769,53771</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33979307$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Allegretti, Andrew S.</creatorcontrib><creatorcontrib>Parada, Xavier Vela</creatorcontrib><creatorcontrib>Endres, Paul</creatorcontrib><creatorcontrib>Zhao, Sophia</creatorcontrib><creatorcontrib>Krinsky, Scott</creatorcontrib><creatorcontrib>St. Hillien, Shelsea A.</creatorcontrib><creatorcontrib>Kalim, Sahir</creatorcontrib><creatorcontrib>Nigwekar, Sagar U.</creatorcontrib><creatorcontrib>Flood, James G.</creatorcontrib><creatorcontrib>Nixon, Andrea</creatorcontrib><creatorcontrib>Simonetto, Douglas A.</creatorcontrib><creatorcontrib>Juncos, Luis A.</creatorcontrib><creatorcontrib>Karakala, Nithin</creatorcontrib><creatorcontrib>Wadei, Hani M.</creatorcontrib><creatorcontrib>Regner, Kevin R.</creatorcontrib><creatorcontrib>Belcher, Justin M.</creatorcontrib><creatorcontrib>Nadim, Mitra K.</creatorcontrib><creatorcontrib>Garcia-Tsao, Guadalupe</creatorcontrib><creatorcontrib>Velez, Juan Carlos Q.</creatorcontrib><creatorcontrib>Parikh, Samir M.</creatorcontrib><creatorcontrib>Chung, Raymond T.</creatorcontrib><creatorcontrib>HRS-HARMONY study investigators</creatorcontrib><creatorcontrib>on behalf of the HRS-HARMONY study investigators</creatorcontrib><title>Urinary NGAL as a Diagnostic and Prognostic Marker for Acute Kidney Injury in Cirrhosis: A Prospective Study</title><title>Clinical and translational gastroenterology</title><addtitle>Clin Transl Gastroenterol</addtitle><description>Urinary neutrophil gelatinase-associated lipocalin (NGAL) has shown promise in differentiating acute tubular necrosis (ATN) from other types of acute kidney injuries (AKIs) in cirrhosis, particularly hepatorenal syndrome (HRS). However, NGAL is not currently available in clinical practice in North America.
Urinary NGAL was measured in a prospective cohort of 213 US hospitalized patients with decompensated cirrhosis (161 with AKI and 52 reference patients without AKI). NGAL was assessed for its ability to discriminate ATN from non-ATN AKI and to predict 90-day outcomes.
Among patients with AKI, 57 (35%) had prerenal AKI, 55 (34%) had HRS, and 49 (30%) had ATN, with a median serum creatinine of 2.0 (interquartile range 1.5, 3.0) mg/dL at enrollment. At an optimal cutpoint of 244 μg/g creatinine, NGAL distinguished ATN (344 [132, 1,429] μg/g creatinine) from prerenal AKI (45 [0, 154] μg/g) or HRS (110 [50, 393] μg/g; P < 0.001), with a C statistic of 0.762 (95% confidence interval 0.682, 0.842). By 90 days, 71 of 213 patients (33%) died. Higher median NGAL was associated with death (159 [50, 865] vs 58 [0, 191] μg/g; P < 0.001). In adjusted and unadjusted analysis, NGAL significantly predicted 90-day transplant-free survival (P < 0.05 for all Cox models) and outperformed Model for End-Stage Liver Disease score by C statistic (0.697 vs 0.686; P = 0.04), net reclassification index (37%; P = 0.008), and integrated discrimination increment (2.7%; P = 0.02).
NGAL differentiates the type of AKI in cirrhosis and may improve prediction of mortality; therefore, it holds potential to affect management of AKI in cirrhosis.</description><subject>Acute Kidney Injury - diagnosis</subject><subject>Acute Kidney Injury - etiology</subject><subject>Acute Kidney Injury - mortality</subject><subject>Acute Kidney Injury - urine</subject><subject>Ascites</subject><subject>Biomarkers - urine</subject><subject>Creatinine</subject><subject>Diagnosis, Differential</subject><subject>Female</subject><subject>Hepatorenal Syndrome - diagnosis</subject><subject>Hepatorenal Syndrome - urine</subject><subject>Humans</subject><subject>Kidney Tubular Necrosis, Acute - diagnosis</subject><subject>Kidney Tubular Necrosis, Acute - urine</subject><subject>Kidneys</subject><subject>Lipocalin-2 - urine</subject><subject>Liver</subject><subject>Liver cirrhosis</subject><subject>Liver Cirrhosis - complications</subject><subject>Liver diseases</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Reproducibility of Results</subject><subject>Survival Analysis</subject><subject>Transplants & implants</subject><subject>United States - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical and translational gastroenterology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Allegretti, Andrew S.</au><au>Parada, Xavier Vela</au><au>Endres, Paul</au><au>Zhao, Sophia</au><au>Krinsky, Scott</au><au>St. Hillien, Shelsea A.</au><au>Kalim, Sahir</au><au>Nigwekar, Sagar U.</au><au>Flood, James G.</au><au>Nixon, Andrea</au><au>Simonetto, Douglas A.</au><au>Juncos, Luis A.</au><au>Karakala, Nithin</au><au>Wadei, Hani M.</au><au>Regner, Kevin R.</au><au>Belcher, Justin M.</au><au>Nadim, Mitra K.</au><au>Garcia-Tsao, Guadalupe</au><au>Velez, Juan Carlos Q.</au><au>Parikh, Samir M.</au><au>Chung, Raymond T.</au><aucorp>HRS-HARMONY study investigators</aucorp><aucorp>on behalf of the HRS-HARMONY study investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Urinary NGAL as a Diagnostic and Prognostic Marker for Acute Kidney Injury in Cirrhosis: A Prospective Study</atitle><jtitle>Clinical and translational gastroenterology</jtitle><addtitle>Clin Transl Gastroenterol</addtitle><date>2021-05-11</date><risdate>2021</risdate><volume>12</volume><issue>5</issue><spage>e00359</spage><epage>e00359</epage><pages>e00359-e00359</pages><issn>2155-384X</issn><eissn>2155-384X</eissn><abstract>Urinary neutrophil gelatinase-associated lipocalin (NGAL) has shown promise in differentiating acute tubular necrosis (ATN) from other types of acute kidney injuries (AKIs) in cirrhosis, particularly hepatorenal syndrome (HRS). However, NGAL is not currently available in clinical practice in North America.
Urinary NGAL was measured in a prospective cohort of 213 US hospitalized patients with decompensated cirrhosis (161 with AKI and 52 reference patients without AKI). NGAL was assessed for its ability to discriminate ATN from non-ATN AKI and to predict 90-day outcomes.
Among patients with AKI, 57 (35%) had prerenal AKI, 55 (34%) had HRS, and 49 (30%) had ATN, with a median serum creatinine of 2.0 (interquartile range 1.5, 3.0) mg/dL at enrollment. At an optimal cutpoint of 244 μg/g creatinine, NGAL distinguished ATN (344 [132, 1,429] μg/g creatinine) from prerenal AKI (45 [0, 154] μg/g) or HRS (110 [50, 393] μg/g; P < 0.001), with a C statistic of 0.762 (95% confidence interval 0.682, 0.842). By 90 days, 71 of 213 patients (33%) died. Higher median NGAL was associated with death (159 [50, 865] vs 58 [0, 191] μg/g; P < 0.001). In adjusted and unadjusted analysis, NGAL significantly predicted 90-day transplant-free survival (P < 0.05 for all Cox models) and outperformed Model for End-Stage Liver Disease score by C statistic (0.697 vs 0.686; P = 0.04), net reclassification index (37%; P = 0.008), and integrated discrimination increment (2.7%; P = 0.02).
NGAL differentiates the type of AKI in cirrhosis and may improve prediction of mortality; therefore, it holds potential to affect management of AKI in cirrhosis.</abstract><cop>United States</cop><pub>Wolters Kluwer</pub><pmid>33979307</pmid><doi>10.14309/ctg.0000000000000359</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2155-384X |
| ispartof | Clinical and translational gastroenterology, 2021-05, Vol.12 (5), p.e00359-e00359 |
| issn | 2155-384X 2155-384X |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8116001 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central |
| subjects | Acute Kidney Injury - diagnosis Acute Kidney Injury - etiology Acute Kidney Injury - mortality Acute Kidney Injury - urine Ascites Biomarkers - urine Creatinine Diagnosis, Differential Female Hepatorenal Syndrome - diagnosis Hepatorenal Syndrome - urine Humans Kidney Tubular Necrosis, Acute - diagnosis Kidney Tubular Necrosis, Acute - urine Kidneys Lipocalin-2 - urine Liver Liver cirrhosis Liver Cirrhosis - complications Liver diseases Male Medical prognosis Middle Aged Mortality Prognosis Prospective Studies Reproducibility of Results Survival Analysis Transplants & implants United States - epidemiology |
| title | Urinary NGAL as a Diagnostic and Prognostic Marker for Acute Kidney Injury in Cirrhosis: A Prospective Study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-28T00%3A15%3A16IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Urinary%20NGAL%20as%20a%20Diagnostic%20and%20Prognostic%20Marker%20for%20Acute%20Kidney%20Injury%20in%20Cirrhosis:%20A%20Prospective%20Study&rft.jtitle=Clinical%20and%20translational%20gastroenterology&rft.au=Allegretti,%20Andrew%20S.&rft.aucorp=HRS-HARMONY%20study%20investigators&rft.date=2021-05-11&rft.volume=12&rft.issue=5&rft.spage=e00359&rft.epage=e00359&rft.pages=e00359-e00359&rft.issn=2155-384X&rft.eissn=2155-384X&rft_id=info:doi/10.14309/ctg.0000000000000359&rft_dat=%3Cproquest_pubme%3E2526302546%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2880950585&rft_id=info:pmid/33979307&rfr_iscdi=true |