title: Serum and urinary biomarkers that predict hepatorenal syndrome in patients with advanced cirrhosis.
abstract: BACKGROUND
  Prediction of hepatorenal syndrome (HRS) remains difficult in advanced cirrhotic patients.
  
  
  OBJECTIVE
  To evaluate use of serum and urine biomarkers to predict HRS.
  
  
  METHODS
  We prospectively recruited Child's B or C cirrhotic patients with normal serum creatinine, and followed them for 12 weeks for the development of HRS. Serum Cystatin C (CysC), serum and urine Neutrophil Gelatinase-Associated Lipocalin (NGAL), serum and urine IL-18, serum N-acetyl-β-d glucosaminidase (NAG), urine kidney injury molecule-1 (KIM-1) and urine liver-type fatty acid binding protein (LFABP) were measured at recruitment (baseline), and their relationship with subsequent HRS investigated.
  
  
  RESULTS
  43 patients were included. 12 (27.9%) developed HRS at 7.3±5.1 weeks from baseline. Logistic regression analysis showed that baseline urinary NGAL and urinary KIM-1 were significantly associated with the development of HRS (RR 1.007, 95% CI 1.001-1.012, p=0.014; RR 1.973, 95% CI 1.002-3.886, p=0.049). The cut-off values for NGAL and KIM-1 to predict HRS were 18.72ng/mL and 1.499ng/mL respectively (AUCs 0.84, p=0.005; and 0.78, p=0.008).
  
  
  CONCLUSIONS
  Urinary NGAL and KIM-1 could serve as biomarkers to predict HRS in advanced cirrhotic patients.
authors.affiliation: Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong. Electronic address: desmondy@hku.hk.
authors.forename: Desmond Y H
authors.initials: DY
authors.lastname: Yap
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
authors.forename: Wai Kay
authors.initials: WK
authors.lastname: Seto
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
authors.forename: James
authors.initials: J
authors.lastname: Fung
authors.affiliation: Division of Liver Transplantation, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
authors.forename: Siu Ho
authors.initials: SH
authors.lastname: Chok
authors.affiliation: Division of Liver Transplantation, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
authors.forename: See Ching
authors.initials: SC
authors.lastname: Chan
authors.affiliation: Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
authors.forename: Gary C W
authors.initials: GC
authors.lastname: Chan
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
authors.forename: Man Fung
authors.initials: MF
authors.lastname: Yuen
authors.affiliation: Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
authors.forename: Tak Mao
authors.initials: TM
authors.lastname: Chan
mesh_terms: D000118:Acetylglucosaminidase / Q000097:blood / Q000652:urine; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood* / Q000652:urine*; D055316:Cystatin C / Q000097:blood; D050556:Fatty Acid-Binding Proteins / Q000652:urine; D005260:Female; D000072596:Hepatitis A Virus Cellular Receptor 1 / Q000097:blood; D006530:Hepatorenal Syndrome / Q000175:diagnosis* / Q000453:epidemiology*; D006723:Hong Kong; D006801:Humans; D020382:Interleukin-18 / Q000097:blood / Q000652:urine; D000071068:Lipocalin-2 / Q000097:blood / Q000652:urine; D008103:Liver Cirrhosis / Q000150:complications*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D055316:Cystatin C; D050556:Fatty Acid-Binding Proteins; C491143:HAVCR1 protein, human; D000072596:Hepatitis A Virus Cellular Receptor 1; D020382:Interleukin-18; D000071068:Lipocalin-2; D000118:Acetylglucosaminidase
keywords: Advanced cirrhosis; Biomarkers; Hepatorenal syndrome