title: Urine neutrophil gelatinase-associated lipocalin: a diagnostic and prognostic marker for acute kidney injury (AKI) in hospitalized cirrhotic patients with AKI-prone conditions.
abstract: BACKGROUND
  Acute kidney injury (AKI) is known to increase mortality in hospitalized cirrhotic patients; therefore early identification is utmost significance. There are only a few studies evaluating the cut-off level of urine neutrophil gelatinase-associated lipocalin (uNGAL) for diagnosing AKI and its prognostic value in cirrhotic patients. We aimed to determine the accuracy of uNGAL as a biomarker for early identification of AKI and to determine the cut-off level of uNGAL for diagnosing AKI in hospitalized cirrhotic patients; and (2) to explore the association of 30-day liver-related mortality with uNGAL level.
  
  
  METHODS
  We prospectively enrolled cirrhotic patients admitted at the King Chulalongkorn Memorial Hospital during May 1, 2011 to Dec 31, 2013. UNGAL levels were measured within 24 h after admission. Clinical and laboratory data were obtained. Patients were followed up to 30 days.
  
  
  RESULTS
  Of 137 cirrhotic hospitalized patients, 121 cirrhotic patients (88.3 %) with AKI-prone conditions were included with mean age of 57.3 ± 14.7 years. Thirty-five patients (29 %) developed AKI within 72 h of admission. The causes of AKI were prerenal azotemia (68.6 %), acute tubular necrosis (25.7 %), hepatorenal syndrome (5.7 %), respectively. The mean uNGAL level was significantly higher in the patients who developed AKI compared with those who did not (290.6 ± 356.3 vs. 54.4 ± 73.7 ng/mL; P = 0.0001). The AUC of uNGAL for diagnosing AKI was 0.83 (95 % [CI]: 0.76-0.91) with the optimal cut-off level of 56 ng/mL, providing 77.1 % sensitivity and 73.3 % specificity. Fourteen percent of subjects died during the 30-day follow-up period. The mean uNGAL levels were significantly higher in the mortality group. The AUC of uNGAL in predicting mortality was 0.75 (95 % [CI]: 0.66-0.85), with a best cut-off level of 72 ng/mL providing 70.6 % sensitivity and 69.2 % specificity. However, in multivariate logistic regression analysis, uNGAL is not an independent factor for 30-day liver-related mortality prediction.
  
  
  CONCLUSIONS
  uNGAL is a valid marker for the early detection of AKI in hospitalized cirrhotic patients with AKI-prone conditions; however, its level could not independently predict 30-day liver-related mortality.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Faculty of Medicine, and King Chulalongkorn Memorial Hospital, Chulalongkorn University, Rama4 Road, Pathumwan District, Bangkok, 10330, Thailand. battan5410@gmail.com.
authors.forename: Sombat
authors.initials: S
authors.lastname: Treeprasertsuk
authors.affiliation: Division of Gastroenterology, Department of Medicine, Faculty of Medicine, and King Chulalongkorn Memorial Hospital, Chulalongkorn University, Rama4 Road, Pathumwan District, Bangkok, 10330, Thailand. nuttu62@yahoo.com.
authors.forename: Amornpun
authors.initials: A
authors.lastname: Wongkarnjana
authors.affiliation: Division of Gastroenterology, Department of Medicine, Faculty of Medicine, and King Chulalongkorn Memorial Hospital, Chulalongkorn University, Rama4 Road, Pathumwan District, Bangkok, 10330, Thailand. veeravich_j@hotmail.com.
authors.forename: Veeravich
authors.initials: V
authors.lastname: Jaruvongvanich
authors.affiliation: Division of Gastroenterology, Department of Medicine, Faculty of Medicine, and King Chulalongkorn Memorial Hospital, Chulalongkorn University, Rama4 Road, Pathumwan District, Bangkok, 10330, Thailand. sasi_mimh@hotmail.com.
authors.forename: Sasipim
authors.initials: S
authors.lastname: Sallapant
authors.affiliation: Division of Nephrology, Department of Medicine, Faculty of Medicine, and King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, 10330, Thailand. khajohn_t@yahoo.com.
authors.forename: Khajohn
authors.initials: K
authors.lastname: Tiranathanagul
authors.affiliation: Division of Gastroenterology, Department of Medicine, Faculty of Medicine, and King Chulalongkorn Memorial Hospital, Chulalongkorn University, Rama4 Road, Pathumwan District, Bangkok, 10330, Thailand. piyawat.komolmit@gmail.com.
authors.forename: Piyawat
authors.initials: P
authors.lastname: Komolmit
authors.affiliation: Department of Biochemistry, Faculty of Medicine, and King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, 10330, Thailand. pisittkvn@yahoo.com.
authors.forename: Pisit
authors.initials: P
authors.lastname: Tangkijvanich
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology; D000209:Acute-Phase Proteins / Q000652:urine*; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000652:urine; D042241:Early Diagnosis; D005260:Female; D006760:Hospitalization; D006801:Humans; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine*; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality / Q000652:urine*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000652:urine*; D012680:Sensitivity and Specificity
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins