title: Urinary neutrophil gelatinase-associated lipocalin predicts mortality and identifies acute kidney injury in cirrhosis.
abstract: BACKGROUND
  Kidney failure predicts mortality in patients with cirrhosis. Identification of kidney failure etiology and recognition of those at the highest mortality risk remains a challenge.
  
  
  OBJECTIVE
  We hypothesized that urinary neutrophil gelatinase-associated lipocalin (uNGAL) predicts mortality and identifies hepatorenal syndrome (HRS) in patients with cirrhosis.
  
  
  METHODS
  Prospectively enrolled patients with cirrhosis were investigated by uNGAL immunoblot upon hospital admission. Kidney failure type was determined blinded to NGAL measurements.
  
  
  RESULTS
  One hundred eighteen patients were enrolled. Fifty-two (44 %) patients had normal kidney function, 14 (12 %) stable chronic kidney disease, 17 (14 %) prerenal azotemia, 20 (17 %) HRS, and 15 (13 %) intrinsic acute kidney injury (iAKI). Patients with HRS had uNGAL levels intermediate between prerenal azotemia [median (IQR) 105 (27.5-387.5) vs. 20 (15-45) ng/mL, p = 0.004] and iAKI [325 (100-700), p < 0.001]. Fifteen (13 %) patients died. In unadjusted analysis, uNGAL predicted inpatient mortality (OR 2.00, 95 % CI 1.36-2.94) and mortality or liver transplantation (OR 2.01, 95 % CI 1.42-2.85). In multiple regression models, uNGAL > 110 ng/mL (OR 6.05, 95 % CI 1.35-27.2) and HRS (OR 6.71, 95 % CI 1.76-25.5) independently predicted mortality, adjusting for age and serum creatinine >1.5 mg/dL.
  
  
  CONCLUSIONS
  uNGAL strongly predicts short-term inpatient mortality in both unadjusted and adjusted models. Patients with HRS may have uNGAL levels intermediate between those with prerenal azotemia and iAKI. Further studies are needed to determine if uNGAL can improve discrimination of HRS from other types of acute kidney injury and predict short- and long-term cirrhosis outcomes.
authors.affiliation: Division of Digestive and Liver Diseases, Department of Medicine, Center for Liver Disease and Transplantation, Columbia University College of Physicians and Surgeons, 622 West 168th St, PH 20, New York, NY 10032, USA. ev77@columbia.edu
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Verna
authors.forename: Robert S
authors.initials: RS
authors.lastname: Brown
authors.forename: Erica
authors.initials: E
authors.lastname: Farrand
authors.forename: Elsa M
authors.initials: EM
authors.lastname: Pichardo
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Forster
authors.forename: David A
authors.initials: DA
authors.lastname: Sola-Del Valle
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Adkins
authors.forename: Meghan E
authors.initials: ME
authors.lastname: Sise
authors.forename: Juan A
authors.initials: JA
authors.lastname: Oliver
authors.forename: Jai
authors.initials: J
authors.lastname: Radhakrishnan
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Barasch
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Nickolas
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D000209:Acute-Phase Proteins / Q000235:genetics / Q000378:metabolism / Q000652:urine*; D000328:Adult; D000368:Aged; D015415:Biomarkers; D015331:Cohort Studies; D005260:Female; D005786:Gene Expression Regulation / Q000502:physiology*; D020022:Genetic Predisposition to Disease; D006801:Humans; D000071068:Lipocalin-2; D054834:Lipocalins / Q000235:genetics / Q000378:metabolism / Q000652:urine*; D008103:Liver Cirrhosis / Q000150:complications / Q000378:metabolism / Q000401:mortality* / Q000652:urine; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011518:Proto-Oncogene Proteins / Q000235:genetics / Q000378:metabolism / Q000652:urine*; D012307:Risk Factors
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins