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Early predictors of acute kidney injury in patients with cirrhosis and bacterial infection: urinary neutrophil gelatinase-associated lipocalin and cardiac output as reliable tools.

Ximenes RO, Farias AQ, Helou CM - Kidney Res Clin Pract (2015)

Bottom Line: Patients with AKI showed higher uNGAL levels than those without AKI from 6 hours to 48 hours.The best accuracy using the cutoff values of 68 ng uNGAL/mg creatinine was achieved at 48 hours when we distinguished patients with and without AKI in all cases.In Group II, we diagnosed AKI in 4 of 9 patients, and cardiac output was significantly higher in patients who developed AKI at 0 hours.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.

ABSTRACT

Background: Hemodynamic abnormalities and acute kidney injury (AKI) are often present in infected cirrhotic patients. Hence, an early diagnosis of AKI is necessary, which might require the validation of new predictors as the determinations of urinary neutrophil gelatinase-associated lipocalin (uNGAL) and cardiac output.

Methods: We evaluated 18 infected cirrhotic patients subdivided into two groups at admission (0 hours). In Group I, we collected urine samples at 0 hours, 6 hours, 24 hours, and 48 hours for uNGAL and fractional excretion of sodium determinations. In Group II, we measured cardiac output using echocardiography.

Results: The age of patients was 55.0±1.9 years, and 11 patients were males. The Model for End-Stage Liver Disease score was 21±1, whereas the Child-Pugh score was C in 11 patients and B in 7 patients. Both patients in Group I and Group II showed similar baseline characteristics. In Group I, we diagnosed AKI in 5 of 9 patients, and the mean time to this diagnosis by measuring serum creatinine was 5.4 days. Patients with AKI showed higher uNGAL levels than those without AKI from 6 hours to 48 hours. The best accuracy using the cutoff values of 68 ng uNGAL/mg creatinine was achieved at 48 hours when we distinguished patients with and without AKI in all cases. In Group II, we diagnosed AKI in 4 of 9 patients, and cardiac output was significantly higher in patients who developed AKI at 0 hours.

Conclusion: Both uNGAL and cardiac output determinations allow the prediction of AKI in infected cirrhotic patients earlier than increments in serum creatinine.

No MeSH data available.


Related in: MedlinePlus

Time course of urinary NGAL. The values of urinary NGAL measured at 0 hours, 6 hours, 24 hours, and 48 hours in infected cirrhotic patients who developed acute kidney injury (◆) or not (■). *P < 0.05 vs. patients without acute kidney injury. NGAL, neutrophil gelatinase-associated lipocalin.
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f0005: Time course of urinary NGAL. The values of urinary NGAL measured at 0 hours, 6 hours, 24 hours, and 48 hours in infected cirrhotic patients who developed acute kidney injury (◆) or not (■). *P < 0.05 vs. patients without acute kidney injury. NGAL, neutrophil gelatinase-associated lipocalin.

Mentions: In Group I, 5 of 9 patients (56%) developed AKI in mean time of 5.4 days that was associated with 100% in-hospital mortality rate. As shown in Table 2 and illustrated in Fig. 1, uNGAL was significantly higher in patients with AKI than in those without AKI at 6 hours, 24 hours, and 48 hours. We also observed that the cutoff values of 68 ng NGAL/mg creatinine stratified better than 130 ng NGAL/mg creatinine with an accuracy of 77.8% to predict AKI (sensitivity, 80%; specificity, 75%; positive predictive value, 80%; and negative predictive value, 75%) at 0 hours. The best accuracy using uNGAL was achieved at 48 hours, which distinguished patients with and without AKI in 100% of cases. However, increments in SCr only occurred after 72 hours, as illustrated in Fig. 2.


Early predictors of acute kidney injury in patients with cirrhosis and bacterial infection: urinary neutrophil gelatinase-associated lipocalin and cardiac output as reliable tools.

Ximenes RO, Farias AQ, Helou CM - Kidney Res Clin Pract (2015)

Time course of urinary NGAL. The values of urinary NGAL measured at 0 hours, 6 hours, 24 hours, and 48 hours in infected cirrhotic patients who developed acute kidney injury (◆) or not (■). *P < 0.05 vs. patients without acute kidney injury. NGAL, neutrophil gelatinase-associated lipocalin.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608870&req=5

f0005: Time course of urinary NGAL. The values of urinary NGAL measured at 0 hours, 6 hours, 24 hours, and 48 hours in infected cirrhotic patients who developed acute kidney injury (◆) or not (■). *P < 0.05 vs. patients without acute kidney injury. NGAL, neutrophil gelatinase-associated lipocalin.
Mentions: In Group I, 5 of 9 patients (56%) developed AKI in mean time of 5.4 days that was associated with 100% in-hospital mortality rate. As shown in Table 2 and illustrated in Fig. 1, uNGAL was significantly higher in patients with AKI than in those without AKI at 6 hours, 24 hours, and 48 hours. We also observed that the cutoff values of 68 ng NGAL/mg creatinine stratified better than 130 ng NGAL/mg creatinine with an accuracy of 77.8% to predict AKI (sensitivity, 80%; specificity, 75%; positive predictive value, 80%; and negative predictive value, 75%) at 0 hours. The best accuracy using uNGAL was achieved at 48 hours, which distinguished patients with and without AKI in 100% of cases. However, increments in SCr only occurred after 72 hours, as illustrated in Fig. 2.

Bottom Line: Patients with AKI showed higher uNGAL levels than those without AKI from 6 hours to 48 hours.The best accuracy using the cutoff values of 68 ng uNGAL/mg creatinine was achieved at 48 hours when we distinguished patients with and without AKI in all cases.In Group II, we diagnosed AKI in 4 of 9 patients, and cardiac output was significantly higher in patients who developed AKI at 0 hours.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.

ABSTRACT

Background: Hemodynamic abnormalities and acute kidney injury (AKI) are often present in infected cirrhotic patients. Hence, an early diagnosis of AKI is necessary, which might require the validation of new predictors as the determinations of urinary neutrophil gelatinase-associated lipocalin (uNGAL) and cardiac output.

Methods: We evaluated 18 infected cirrhotic patients subdivided into two groups at admission (0 hours). In Group I, we collected urine samples at 0 hours, 6 hours, 24 hours, and 48 hours for uNGAL and fractional excretion of sodium determinations. In Group II, we measured cardiac output using echocardiography.

Results: The age of patients was 55.0±1.9 years, and 11 patients were males. The Model for End-Stage Liver Disease score was 21±1, whereas the Child-Pugh score was C in 11 patients and B in 7 patients. Both patients in Group I and Group II showed similar baseline characteristics. In Group I, we diagnosed AKI in 5 of 9 patients, and the mean time to this diagnosis by measuring serum creatinine was 5.4 days. Patients with AKI showed higher uNGAL levels than those without AKI from 6 hours to 48 hours. The best accuracy using the cutoff values of 68 ng uNGAL/mg creatinine was achieved at 48 hours when we distinguished patients with and without AKI in all cases. In Group II, we diagnosed AKI in 4 of 9 patients, and cardiac output was significantly higher in patients who developed AKI at 0 hours.

Conclusion: Both uNGAL and cardiac output determinations allow the prediction of AKI in infected cirrhotic patients earlier than increments in serum creatinine.

No MeSH data available.


Related in: MedlinePlus