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Korean J Gastroenterol  <  Volume 74(4); 2019 <  Articles

Korean J Gastroenterol 2019; 74(4): 212-218  https://doi.org/10.4166/kjg.2019.74.4.212
Clinical Significance of Urinary Neutrophil Gelatinase-associated Lipocalin Levels in Defining the Various Etiologies of Acute Kidney Injury in Liver Cirrhosis Patients
Jong Ho Lee, Eileen L. Yoon1 , Seong Eun Park1, Ji Young Park1, Jeong Min Choi1, Tae Joo Jeon1, Won Chang Shin1 and Won-Choong Choi1
Department of Internal Medicine, Hankook General Hospital, Cheongju; Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine1, Seoul, Korea
Correspondence to: Eileen L. Yoon, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul 01757, Korea. Tel: +82-2-950-8824, Fax: +82-2-950-8886, E-mail: mseileen80@gmail.com, ORCID: https://orcid.org/0000-0003-0474-048X
Received: April 11, 2019; Revised: July 12, 2019; Accepted: July 24, 2019; Published online: October 25, 2019.
© The Korean Journal of Gastroenterology. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background/Aims: A diagnosis of hepatorenal syndrome (HRS) is based on a differential evaluation of acute kidney injury (AKI), which may aggravate the clinical course. This study assessed the clinical significance of the urinary neutrophil gelatinase- associated lipocalin (u-NGAL) levels in a differential diagnosis of AKI in patients with liver cirrhosis (LC).
Methods: Patients with LC who developed AKI were enrolled prospectively. Clinically, patients with AKI were classified into prerenal azotemia (PRA), HRS, and acute tubular necrosis (ATN) groups.
Results:Fifty-five patients (male, 74.5%) with LC who exhibited AKI upon admission were enrolled; 28, 9, and 18 patients were included in the PRA, HRS, and ATN groups, respectively. The baseline model for end-stage liver disease (MELD) scores was similar in the subgroups. The median event creatinine level, measured at the time of the AKI diagnosis, was similar in the HRS and ATN subgroups. On the other hand, the median event u-NGAL level differed significantly between the three subgroups (PRA, HRS, and ATN: 37 vs. 134 vs. 2,625 ng/mL, p=0.003). In particular, the median u-NGAL level of the HRS group was clearly different from those of the PRA (p<0.001) and ATN (p<0.001) groups. Multivariable analysis revealed the natural logarithm of the u-NGAL level (hazard ratio [HR] 1.77, p=0.031) and the MELD score (HR 1.17, p=0.027) to be independent prognostic factors for in-hospital mortality in patients with LC and AKI.
Conclusions: The median u-NGAL level differentiated HRS from ATN and served as a clinical indicator of in-hospital mortality for patients with LC and AKI.
Keywords: Lipocalins; Acute kidney injury; Hepatorenal syndrome; Kidney tubular necrosis, acute; Liver cirrhosis

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