간경변증 환자의 급성 신부전 발생에 대한 소변 내 호중구 젤라틴 분해효소 연관 리포칼린의 임상적 의의

• Published in: The Korean journal of gastroenterology Vol. 74; no. 4; pp. 212 - 218
• Main Authors: 이종호, Jong Ho Lee, 윤아일린, Eileen L. Yoon, 박성은, Seong Eun Park, 박지영, Ji Young Park, 최정민, Jeong Min Choi, 전태주, Tae Joo Jeon, 신원창, Won Chang Shin, 최원충, Won-choong Choi
• Format: Journal Article
• Language: Korean
• Published: 대한소화기학회 31.10.2019
• Subjects: acute; Liver cirrhosis; Lipocalins; Acute kidney injury; Hepatorenal syndrome; Kidney tubular necrosis
• ISSN: 1598-9992

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. (Korean J Gastroenterol 2019;74:212-218)