Urinary neutrophil gelatinase-associated lipocalin predicts kidney outcome and death in patients with cirrhosis and bacterial infections

Background 82 Aims: Infections in cirrhosis are frequently complicated by kidney dysfunction that entails a poor prognosis. Urinary biomarkers may be of potential clinical usefulness in this setting. We aimed at assessing the value of urinary neutrophil gelatinase-associated lipocalin (uNGAL), a biomarker overexpressed in kidney tubules during kidney injury, in predicting clinical outcomes in cirrhosis with infections. Methods: One-hundred and thirty-two consecutive patients hospitalized with infections were evaluated prospectively. Acute kidney injury (AKI) was defined according to AKIN criteria. uNGAL was measured at infection diagnosis and at days 3 and 7 (ELISA, Bioporto, DK). Results: Patients with AKI (n = 65) had significantly higher levels of uNGAL compared to patients without AKI (203 +/- 390 vs. 79 +/- 126 mu g/g creatinine, p <0.001). Moreover, uNGAL levels were significantly higher in patients who developed persistent AKI (n = 40), compared to those with transient AKI (n = 25) (281 +/- 477 vs. 85 +/- 79 mu g/g creatinine, p <0.001). Among patients with persistent AKI, uNGAL was able to discriminate type-1 HRS from other causes of AKI (59 +/- 46 vs. 429 +/- 572 mu g/g creatinine, respectively; p <0.001). Moreover, the time course of uNGAL was markedly different between the two groups. Interestingly, baseline uNGAL levels also predicted the development of a second infection during hospitalization. Overall, 3-month mortality was 34%. Independent predictive factors of 3-month mortality were MELD score, serum sodium, and uNGAL levels at diagnosis, but not presence or stage of AKI. Conclusions: In patients with cirrhosis and infections, measurement of urinary NGAL at infection diagnosis is useful in predicting important clinical outcomes, specifically persistency and type of AKI, development of a second infection, and 3-month mortality. (C) 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.