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Abstract: FR-PO009

Role of Plasma Cystatin C and Urine NGAL in Prediction of AKI and Mortality in Patients with Acutely Decompensated Cirrhosis: A Prospective Cohort Study

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Jo, Sang-Kyung, Korea University Anam Hospital, Seongbuk-Gu, SEOUL, Korea (the Republic of)
  • Yang, Jihyun, Korea University Anam Hospital, Seongbuk-Gu, SEOUL, Korea (the Republic of)
  • Lee, Junyong, Korea University Anam Hospital, Seongbuk-Gu, SEOUL, Korea (the Republic of)
  • Oh, Sewon, Korea University Anam Hospital, Seongbuk-Gu, SEOUL, Korea (the Republic of)
  • Kim, Myung-Gyu, Korea University Anam Hospital, Seongbuk-Gu, SEOUL, Korea (the Republic of)
Background

Acute kidney injury (AKI) is the most frequent and devastating complication in cirrhotic patients. Emerging evidence suggests that novel biomarkers could predict AKI earlier than conventional markers and better predict prognosis in these patients.

Methods

To determine the incidence and prognosis of AKI in acutely decompensated cirrhotic patients and also test whether plasma cystatin C, urine neutrophil gelatinase-associated lipocalin (NGAL) or tissue inhibitor of metalloproteinase-2 (TIMP-2), insulin-like growth factor 7 (IGFBP7) could predict the development of AKI and prognosis.

Results

Of 111 patients, 45 (40.5%) developed AKI during hospitalization. Although 53.3% of AKI episodes were transient, stage 1 AKI, overall mortality was significantly higher compared to those without AKI (25% vs. 46.5%, p=0.02). Although initial BUN and serum creatinine were not different, plasma cystatin C and urine NGAL at the time of admission were significantly increased in patients who developed AKI and also death. Plasma cystatin C and urine NGAL were independently associated with the development of AKI after adjusting for clinical variables including age, co-morbidity, and Child-Pugh score. [plasma cystatin C, odds ratio (OR) 2.09; 95% confidence interval (CI), 1.01-4.35), urine NGAL, OR 1.04, CI 1.01-1.05]. Although these biomarkers failed to predict mortality independent of clinical variables, urine NGAL significantly improved the accuracy of MELD in predicting mortality.

Conclusion

The incidence of AKI is high and even minor increase in serum creatinine is associated with high mortality in decompensated cirrhosis. Novel biomarkers including plasma cystatin C or urine NGAL might be useful in the earlier diagnosis of AKI and also in predicting mortality in acutely decompensated cirrhotic patients.