Urinary NGAL as a Diagnostic and Prognostic Marker for Acute Kidney Injury in Cirrhosis: A Prospective Study.
Urinary NGAL as a Diagnostic and Prognostic Marker for Acute Kidney Injury in Cirrhosis: A Prospective Study.
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DOI：
10.14309/ctg.0000000000000359
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发表时间：
2021-05-11
影响因子：
3.6
通讯作者：
HRS-HARMONY study investigators
中科院分区：
文献类型：
--
作者：
Allegretti AS;Parada XV;Endres P;Zhao S;Krinsky S;St Hillien SA;Kalim S;Nigwekar SU;Flood JG;Nixon A;Simonetto DA;Juncos LA;Karakala N;Wadei HM;Regner KR;Belcher JM;Nadim MK;Garcia-Tsao G;Velez JCQ;Parikh SM;Chung RT;HRS-HARMONY study investigators
尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）已显示出区分急性肾小管坏死（ATN）与其他类型的急性肾损伤（AKI）肝硬化，特别是肝肾综合征（HRS）的承诺。然而，NGAL目前在北美的临床实践中不可用。在213例失代偿性肝硬化美国住院患者（161例阿基和52例无阿基的参考患者）的前瞻性队列中测量尿NGAL。评估NGAL区分ATN和非ATN阿基的能力，并预测90天的结果。在阿基患者中，57例（35%）患有肾前性阿基，55例（34%）患有HRS，49例（30%）患有ATN，入组时中位血清肌酐为2.0（四分位距1.5，3.0）mg/dL。在244 μg/g肌酐的最佳临界点，NGAL将ATN（344 [132，1，429] μg/g肌酐）与肾前阿基（45 [0，154] μg/g）或HRS（110 [50，393] μg/g; P < 0.001）区分开来，C统计量为0.762（95%置信区间0.682，0.842）。到90天时，213例患者中有71例（33%）死亡。较高的NGAL中位数与死亡相关（159 [50，865] vs 58 [0，191] μg/g; P < 0.001）。在校正和未校正的分析中，NGAL显著预测90天无移植存活率。（所有考克斯模型P < 0.05），并通过C统计（0.697 vs 0.686; P = 0.04）、净重新分类指数（37%; P = 0.008）和综合判别增量（2.7%; P = 0.02）优于终末期肝病模型评分。NGAL可以区分肝硬化阿基的类型，并可能改善死亡率的预测;因此，它有可能影响肝硬化阿基的管理。
Urinary neutrophil gelatinase-associated lipocalin (NGAL) has shown promise in differentiating acute tubular necrosis (ATN) from other types of acute kidney injuries (AKIs) in cirrhosis, particularly hepatorenal syndrome (HRS). However, NGAL is not currently available in clinical practice in North America. Urinary NGAL was measured in a prospective cohort of 213 US hospitalized patients with decompensated cirrhosis (161 with AKI and 52 reference patients without AKI). NGAL was assessed for its ability to discriminate ATN from non-ATN AKI and to predict 90-day outcomes. Among patients with AKI, 57 (35%) had prerenal AKI, 55 (34%) had HRS, and 49 (30%) had ATN, with a median serum creatinine of 2.0 (interquartile range 1.5, 3.0) mg/dL at enrollment. At an optimal cutpoint of 244 μg/g creatinine, NGAL distinguished ATN (344 [132, 1,429] μg/g creatinine) from prerenal AKI (45 [0, 154] μg/g) or HRS (110 [50, 393] μg/g; P < 0.001), with a C statistic of 0.762 (95% confidence interval 0.682, 0.842). By 90 days, 71 of 213 patients (33%) died. Higher median NGAL was associated with death (159 [50, 865] vs 58 [0, 191] μg/g; P < 0.001). In adjusted and unadjusted analysis, NGAL significantly predicted 90-day transplant-free survival (P < 0.05 for all Cox models) and outperformed Model for End-Stage Liver Disease score by C statistic (0.697 vs 0.686; P = 0.04), net reclassification index (37%; P = 0.008), and integrated discrimination increment (2.7%; P = 0.02). NGAL differentiates the type of AKI in cirrhosis and may improve prediction of mortality; therefore, it holds potential to affect management of AKI in cirrhosis.
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影响因子：
13.5
作者：
Belcher, Justin M.;Garcia-Tsao, Guadalupe;Sanyal, Arun J.;Bhogal, Harjit;Lim, Joseph K.;Ansari, Naheed;Coca, Steven G.;Parikh, Chirag R.
通讯作者：
Parikh, Chirag R.
影响因子：
29.4
作者：
Boyer, Thomas D.;Sanyal, Arun J.;Pappas, Stephen Chris
通讯作者：
Pappas, Stephen Chris
影响因子：
12.6
作者：
Huelin, Patricia;Piano, Salvatore;Gines, Pere
通讯作者：
Gines, Pere
DOI：
10.2215/cjn.03610417
发表时间：
2018-01-06
影响因子：
9.8
作者：
Allegretti, Andrew S.;Parada, Xavier Vela;Thadhani, Ravi I.
通讯作者：
Thadhani, Ravi I.
影响因子：
25.7
作者：
Jalan, Rajiv;Saliba, Faouzi;Arroyo, Vicente
通讯作者：
Arroyo, Vicente