Neutrophil gelatinase-associated lipocalin in prediction of mortality in patients with hepatorenal syndrome: a prospective observational study

• Published in: Liver international 2014-01, Vol.34 (1), p.49-57
• Main Authors: Gungor, Gokhan, Ataseven, Huseyin, Demir, Ali, Solak, Yalcin, Gaipov, Abduzhappar, Biyik, Murat, Ozturk, Bahadir, Polat, Ilker, Kiyici, Aysel, Cakir, Ozlem O., Polat, Hakki
• Format: Article
• Language: English
• Subjects: acute kidney injury; Acute-Phase Proteins - urine; Aged; Area Under Curve; Biomarkers - blood; Biomarkers - urine; Case-Control Studies; cirrhosis; Enzyme-Linked Immunosorbent Assay; Female; hepatorenal syndrome; Hepatorenal Syndrome - blood; Hepatorenal Syndrome - enzymology; Hepatorenal Syndrome - mortality; Hepatorenal Syndrome - urine; Hospital Mortality; Humans; Kaplan-Meier Estimate; Lipocalin-2; Lipocalins - blood; Lipocalins - urine; Male; Middle Aged; mortality; neutrophil gelatinase-associated lipocalin; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Prospective Studies; Proto-Oncogene Proteins - blood; Proto-Oncogene Proteins - urine; Risk Factors; ROC Curve; Time Factors
• ISSN: 1478-3223; 1478-3231
• DOI: 10.1111/liv.12232

Background & Aims Hepatorenal syndrome (HRS) is a severe complication of cirrhosis which is characterized by renal dysfunction and associated with poor survival. Neutrophil gelatinase‐associated lipocalin (NGAL) is a troponin‐like biomarker for human acute kidney injury. We aimed to investigate levels of plasma and urine NGAL in HRS and predictive ability of these markers for all‐cause mortality, in HRS, stable cirrhosis and control subjects. Methods A total of 64 patients with cirrhosis (8 patients with type 1 HRS, 22 with type 2 HRS, and 34 without HRS) and 23 control subjects were included in the study. Blood and urine samples were measured with Human NGAL sandwich ELISA. Patients were followed up prospectively. Results Patients with type 1 and type 2 HRS had significantly higher plasma and urine NGAL levels compared with stable cirrhosis and control subjects. Cox regression analysis showed that plasma NGAL and MELD‐Na scores were independent predictors of mortality. ROC‐curve analysis showed that the plot of the plasma NGAL, urine NGAL, MELD‐Na and Child‐Turcot‐Pugh score could predict all‐cause mortality in cirrhotic patients' area under the curve (AUC 0.819, 0.686, 0.807 and 0.795 respectively). Conclusions NGAL could predict mortality in patients with HRS independent of other commonly used risk factors.