Prognosis predictability of serum and urine renal markers in patients with decompensated cirrhosis: A multicenter prospective study

Tae Hyung Kim, Yeon Seok Seo, Seong Hee Kang, Moon Young Kim, Sang Gyune Kim, Hyo Young Lee, Jeong-Hoon Lee, Young Sun Lee, Ji Hoon Kim, Soung Won Jung, Jae Young Jang, Ki Tae Suk, Young Kul Jung, Hyunggin An, Hyung Joon Yim, Young Seok Kim, Soon Ho Um
Liver International: Official Journal of the International Association for the Study of the Liver 2020 August 4

BACKGROUND & AIMS: This prospective observational study aimed to evaluate the best serum and urine markers to assess predictability for the prognosis of patients with decompensated cirrhosis.

METHODS: Serum creatinine and cystatin C (CysC), and urinary N-acetyl-beta-D glucosaminidase (uNAG) and neutrophil gelatinase-associated lipocalin (uNGAL) levels were measured from hospitalized patients with decompensated cirrhosis.

RESULTS: In total, 328 patients (mean age, 57.2 ± 12.0 years; 237 men) with decompensated cirrhosis were included. Alcoholic liver disease was the most frequent underlying liver disease (68.0%). Acute kidney injury (AKI) was concomitantly present in 41 patients (12.5%) at baseline. INR, serum creatinine and CysC levels, and uNAG and uNGAL levels were significantly higher in patients with AKI. During hospitalization, AKI had progressed in 37 patients (11.3%). In 287 patients without AKI, the incidence of AKI at 3, 6, 9, and 12 months was 15.4%, 22.2%, 28.6%, and 32.5%, respectively. On multivariate analysis, serum CysC and uNAG levels were independent predictors of AKI, and their optimal cutoff values were 1.055 mg/L and 23.1 U/g urinary Cr, respectively. When patients were classified into three groups with these cutoff values of serum CysC and uNAG levels (group 1, both low; group 2, one of two high; and group 3, both high), progression of AKI during hospitalization (P=0.001), incidence of AKI in patients without AKI at baseline (P=0.001), and mortality rate (P<0.001) differed significantly according to serum CysC and uNAG levels.

CONCLUSION: Serum CysC and uNAG levels are useful prognostic markers for renal outcomes and mortality in patients with decompensated cirrhosis.

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