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. 2015 Sep;34(3):140-5.
doi: 10.1016/j.krcp.2015.08.003. Epub 2015 Aug 20.

Early predictors of acute kidney injury in patients with cirrhosis and bacterial infection: urinary neutrophil gelatinase-associated lipocalin and cardiac output as reliable tools

Rafael O Ximenes  1 , Alberto Q Farias  2 , Claudia M B Helou  2
Affiliations

Early predictors of acute kidney injury in patients with cirrhosis and bacterial infection: urinary neutrophil gelatinase-associated lipocalin and cardiac output as reliable tools

Rafael O Ximenes et al. Kidney Res Clin Pract. 2015 Sep.

Abstract

Background: Hemodynamic abnormalities and acute kidney injury (AKI) are often present in infected cirrhotic patients. Hence, an early diagnosis of AKI is necessary, which might require the validation of new predictors as the determinations of urinary neutrophil gelatinase-associated lipocalin (uNGAL) and cardiac output.

Methods: We evaluated 18 infected cirrhotic patients subdivided into two groups at admission (0 hours). In Group I, we collected urine samples at 0 hours, 6 hours, 24 hours, and 48 hours for uNGAL and fractional excretion of sodium determinations. In Group II, we measured cardiac output using echocardiography.

Results: The age of patients was 55.0±1.9 years, and 11 patients were males. The Model for End-Stage Liver Disease score was 21±1, whereas the Child-Pugh score was C in 11 patients and B in 7 patients. Both patients in Group I and Group II showed similar baseline characteristics. In Group I, we diagnosed AKI in 5 of 9 patients, and the mean time to this diagnosis by measuring serum creatinine was 5.4 days. Patients with AKI showed higher uNGAL levels than those without AKI from 6 hours to 48 hours. The best accuracy using the cutoff values of 68 ng uNGAL/mg creatinine was achieved at 48 hours when we distinguished patients with and without AKI in all cases. In Group II, we diagnosed AKI in 4 of 9 patients, and cardiac output was significantly higher in patients who developed AKI at 0 hours.

Conclusion: Both uNGAL and cardiac output determinations allow the prediction of AKI in infected cirrhotic patients earlier than increments in serum creatinine.

Keywords: Acute kidney injury; Cardiac output; Cirrhosis; Hepatorenal syndrome; Neutrophil gelatinase-associated lipocalin.

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Figures

Figure 1
Figure 1
Time course of urinary NGAL. The values of urinary NGAL measured at 0 hours, 6 hours, 24 hours, and 48 hours in infected cirrhotic patients who developed acute kidney injury (◆) or not (■). *P < 0.05 vs. patients without acute kidney injury. NGAL, neutrophil gelatinase-associated lipocalin.
Figure 2
Figure 2
Urinary NGAL and SCr. The levels of urinary NGAL (●) and SCr (▄) in infected cirrhotic patients who developed AKI during hospitalization. AKI, acute kidney injury; NGAL, neutrophil gelatinase-associated lipocalin; SCr, serum creatinine.
Figure 3
Figure 3
Comparisons between patients (Group II) with and without AKI. (A) The levels of SCr. (B) MELD score. (C) The levels of uNGAL. (D) The levels of cardiac output. AKI, acute kidney injury; MELD, Model for End-Stage Liver Disease; NGAL, neutrophil gelatinase-associated lipocalin; N.S., not significant; SCr, serum creatinine.
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