title: Acute renal failure in cirrhotic patients with severe sepsis: value of urinary interleukin-18.
abstract: OBJECTIVE
  Acute renal failure (ARF) is a common complication of liver cirrhosis and severe sepsis. Differentiating functional renal failure from acute tubular necrosis (ATN) has been difficult in this clinical setting. It has been shown that urinary interleukin 18 (IL-18) can serve as a sensitive marker for ARF and ATN. This study was aimed to investigate the diagnostic and prognostic values of urinary IL-18 in ARF associated with liver cirrhosis and severe sepsis.
  
  
  METHODS
  We prospectively evaluated the relationship between urinary IL-18 and clinical outcomes in 168 consecutive cirrhotic patients with severe sepsis.
  
  
  RESULTS
  One hundred and eight patients (64.3%) developed ARF at admission to the intensive care unit. ARF was associated with higher urinary IL-18 and impaired effective arterial volume. Renal failure was functional in 64 (59.2%), due to acute tubular necrosis (ATN) in 30 (27.7%), and mixed type in 14 (12.9%). Patients with ATN had significantly higher levels of urinary IL-18, rates of vasopressor dependency, and hospital mortality than those with functional renal failure. By using the areas under receiver operating characteristic (AUROC) curve, urinary IL-18 demonstrated an excellent discriminative power (AUROC 0.882) for diagnosing tubular injury in those with ARF. Meanwhile, hospital survivors had significantly lower urinary and serum IL-18 levels, compared to non-survivors. In multivariate analysis, urinary IL-18, international normalized ratio, and mean arterial pressure were independent factors to predict hospital mortality.
  
  
  CONCLUSIONS
  Urinary IL-18 can serve as a diagnostic and prognostic marker in cirrhotic patients with severe sepsis.
authors.affiliation: Division of Digestive Therapeutic Endoscopy, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors.forename: Ming-Hung
authors.initials: MH
authors.lastname: Tsai
authors.forename: Yung-Chang
authors.initials: YC
authors.lastname: Chen
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Yang
authors.forename: Chang-Chi
authors.initials: CC
authors.lastname: Jenq
authors.forename: Ji-Tseng
authors.initials: JT
authors.lastname: Fang
authors.forename: Jau-Min
authors.initials: JM
authors.lastname: Lien
authors.forename: Cheng-Chieh
authors.initials: CC
authors.lastname: Hung
authors.forename: Hsu-Huei
authors.initials: HH
authors.lastname: Weng
authors.forename: Cheng-Shyong
authors.initials: CS
authors.lastname: Wu
authors.forename: Yun-Shing
authors.initials: YS
authors.lastname: Peng
authors.forename: Chien-Heng
authors.initials: CH
authors.lastname: Shen
authors.forename: Shui-Yi
authors.initials: SY
authors.lastname: Tung
authors.forename: Ya-Chung
authors.initials: YC
authors.lastname: Tian
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000652:urine*; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001794:Blood Pressure; D001810:Blood Volume; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D020382:Interleukin-18 / Q000097:blood / Q000652:urine*; D019934:International Normalized Ratio; D053208:Kaplan-Meier Estimate; D007683:Kidney Tubular Necrosis, Acute / Q000175:diagnosis / Q000652:urine; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D018805:Sepsis / Q000150:complications; D018709:Statistics, Nonparametric
chemical_list: D020382:Interleukin-18