Early Diagnosis And Prediction Of Prognosis Of Cirrhosis Complicated With Acute Renal Injury By New Biomarkers

BackgroundOur study was to determine whether early detection of Urine neutrophil gelatinase-associated lipocalin after risk factors for acute kidney injury(AKI)occurred related to 90-day mortality in patients with cirrhosis.MethodsWe conducted a prospective nested case-control study of 141 cirrhotic patients with risk factors(bacterial infections,bleeding from oesophageal varices,large volume paracentesis(>3L/d),increased dosage of diuretics,and receiving contrast medium)admitted to Ningbo NO.2 Hospital from June 2016 to December 2016.Urine samples were collected at the time of risk factors occurred and 1d?2d and 3d after the risk factors.Blood samples were collected at the time of risk factors occurred and 3d and 7d after the risk factors.Among them,we observed 11 patients diagnosed as AKI.9 patients were selected as controls,uNGAL was measured by ELISA.All the patients were followed up for 90 days,The end point was the hazard of death.The prognostic value of urinary NGAL was demonstrated by using the area under ROC curve(AUC)evaluation metric.90-d survival probability curves of AKI and control group were calculated with the Kaplan-Meier method.ResultsThere were no significant differences in terms of baseline characteristics between AKI and control group.In the AKI group,the levels of uNGAL of 1-day,2-day and 3-day after risk factors were significantly higher than those at the time of risk factors happened(P=0.013,P=0.009,P=0.012).The rate of mortality was much higher in patients with AKI compared with control group patients(P < 0.05).uNGAL level of 1d and 2d after risk factors was significantly higher in deceased patients compared with those in surviving patients,(P=0.049,P=0.039).ROC curve analysis showed that the plot of the uNGAL of 1-day and 2-day after risk factors could predict the risk of 90-day mortality in cirrhotic patients(AUC=0.792(95%CI: 0.526-1.000),P=0.049;AUC=0.806(95%CI: 0.584-1.000),P=0.039,respectively).Multivariate Cox regression analysis showed that uNGAL value of 2d after risk factors and MELD score independently predict 90-d mortality.ConclusionThe increase of urine NGAL happend in early stage of liver cirrhosis occur high risk factors of AKI.The change urine NGAL level can indicate the occurrence of AKI.Early detection(1-2 days)of uNGAL after risk factors for cirrhosis-AKI occurred could predict 90-day mortality in cirrhotic patients with AKI...