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Grønbaek H, Møller HJ, Saliba F, Zeuzem S, Albillos A, Ariza X, Graupera I, Solà E, Amoros A, Pavesi M, Bossen L, Jalan R, Gines P, Arroyo V. Improved prediction of mortality by combinations of inflammatory markers and standard clinical scores in patients with acute-on-chronic liver failure and acute decompensation. J Gastroenterol Hepatol 2021; 36:240-248. [PMID: 32478437 DOI: 10.1111/jgh.15125] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/14/2020] [Accepted: 05/25/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Acute-on-chronic liver failure (ACLF) is a sinister prognosis, and there is a need for accurate biomarkers and scoring systems to better characterize ACLF patients and predict prognosis. Systemic inflammation and renal failure are hallmarks in ACLF disease development and progression. We hypothesized that the combination of specific inflammatory markers in combination with clinical scores are better predictors of survival than the originally developed CLIF-C acute decompensation (AD) and CLIF-C ACLF scores. METHODS We reevaluated all previously measured inflammatory markers in 522 patients from the CANONIC study, 342 without and 180 with ACLF. We used the Harrell's C-index to determine the best marker alone or in combination with the original scores and calculated new scores for prediction of mortality in the original CANONIC cohort. RESULTS The best markers to predict 90-day mortality in patients without ACLF were the plasma macrophage activation markers soluble (s)CD163 and mannose receptor (sMR). Urinary neutrophil gelatinase associated lipocalin (UNGAL) and sCD163 were predictors for 28-day mortality in patients with ACLF. The newly developed CLIF-C AD + sMR score in patients without ACLF improved 90-day mortality prediction compared with the original CLIF-C AD score (C-index 0.82 [0.78-0.86] vs 0.74 [0.70-0.78, P = 0.004]). Further, the new CLIF-C ACLF + sCD163 + UNGAL improved the original CLIF-C ACLF score for 28-day mortality (0.85 [0.79-0.91] vs 0.75 [0.70-0.80], P = 0.039). CONCLUSIONS The capability of these inflammatory markers to improve the original prognostic scores in cirrhosis patients without and with ACLF points to a key role of macrophage activation and inflammation in the development and progression of AD and ACLF.
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Affiliation(s)
- Henning Grønbaek
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Holger Jon Møller
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Faouzi Saliba
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, INSERM, Unité 1193, Villejuif, France
| | - Stefan Zeuzem
- Medical Clinik I, Department of Internal Medicine, J.W. Goethe University Hospital, Frankfurt/Main, Germany
| | - Agustin Albillos
- Department of Gastroenterology, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, CIBEREHD, Madrid, Spain
| | - Xavier Ariza
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
| | - Isabel Graupera
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
| | - Elsa Solà
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
| | - Alex Amoros
- European Foundation for the Study of Chronic Liver Failure (EF-CLIF), Barcelona, Spain
| | - Marco Pavesi
- European Foundation for the Study of Chronic Liver Failure (EF-CLIF), Barcelona, Spain
| | - Lars Bossen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Rajiv Jalan
- UCL Institute for Liver and Digestive Health, University College London, London, UK
| | - Pere Gines
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
| | - Vicente Arroyo
- European Foundation for the Study of Chronic Liver Failure (EF-CLIF), Barcelona, Spain
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Nada A, Abbasy M, Sabry A, Abdu Allah AM, Shehab-Eldeen S, Elnaidany N, Elimam H, Mohamed Ibraheem KI, Essa A. Serum Neutrophil Gelatinase-Associated Lipocalin (NGAL) in HCV-Positive Egyptian Patients Treated with Sofosbuvir. Can J Gastroenterol Hepatol 2020; 2020:1632959. [PMID: 32083035 PMCID: PMC7007947 DOI: 10.1155/2020/1632959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 12/23/2019] [Indexed: 02/06/2023] Open
Abstract
Background Direct-acting antivirals (DAAs) made a drastic change in the management of HCV infection. Sofosbuvir is one of the highly potent DAAs, eliminated mainly through the kidney. But concerns about renal safety during treatment may limit its use. Neutrophil gelatinase-associated lipocalin (NGAL) has been proven as a predictor of renal tubular injury. Hence, the aim of this work was to assess serum neutrophil gelatinase-associated lipocalin (NGAL) in HCV-positive patients before and after treatment with the sofosbuvir-based antiviral regimen. Methods This prospective study included 87 Egyptian patients with chronic HCV infection treated with sofosbuvir plus daclatasvir with or without ribavirin for 12 weeks. Serum NGAL was measured before and at the end of treatment (EOT). Analysis of NGAL and estimated glomerular filtration rate (eGFR) evolution was done. Results Our results showed a statistically significant decrease in serum NGAL (P=0.02) with a nonsignificant reduction in eGFR (P=0.02) with a nonsignificant reduction in eGFR (P=0.02) with a nonsignificant reduction in eGFR (P=0.02) with a nonsignificant reduction in eGFR (P=0.02) with a nonsignificant reduction in eGFR (. Conclusions Sofosbuvir appears to have no nephrotoxic effects and is safe to treat patients with chronic HCV infection.
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Affiliation(s)
- Ali Nada
- Hepatology Department, National Liver Institute, Menoufia University, Shebin-Elkom, Egypt
| | - Mohamed Abbasy
- Hepatology Department, National Liver Institute, Menoufia University, Shebin-Elkom, Egypt
| | - Aliaa Sabry
- Hepatology Department, National Liver Institute, Menoufia University, Shebin-Elkom, Egypt
| | - Azza Mohamed Abdu Allah
- Biochemistry and Molecular Biology Department, Faculty of Medicine, Menoufia University, Shebin-Elkom, Egypt
| | - Somaia Shehab-Eldeen
- Tropical Medicine Department, Faculty of Medicine, Menoufia University, Shebin-Elkom, Egypt
| | - Nada Elnaidany
- Faculty of Pharmacy, MSA University, 6th of October City, Egypt
| | - Hanan Elimam
- Biochemistry Department, Faculty of Pharmacy, University of Sadat City, Sadat City, Egypt
| | | | - Abdallah Essa
- Tropical Medicine Department, Faculty of Medicine, Menoufia University, Shebin-Elkom, Egypt
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Sueud T, Hadi NR, Abdulameer R, Jamil DA, Al-Aubaidy HA. Assessing urinary levels of IL-18, NGAL and albumin creatinine ratio in patients with diabetic nephropathy. Diabetes Metab Syndr 2019; 13:564-568. [PMID: 30641767 DOI: 10.1016/j.dsx.2018.11.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 11/02/2018] [Indexed: 01/05/2023]
Abstract
AIMS Diabetic nephropathy (DN) is a serious microvascular complication of a longstanding hyperglycemia. This study aims to evaluate whether urinary neutrophil gelatinase-associated lipocalin (NGAL) and urinary Interleukin-18 possess a better diagnostic value than albumin creatinine ratio in assessing the severity of nephropathy in patients with type 2 diabetes mellitus (T2DM). MATERIAL & METHODS Ninety participants diagnosed with T2DM were recruited and they were divided into three study groups according to their albumin/creatinine ratio (ACR): (Normoalbuminuria group, Microalbuminuria group, and Macroalbuminuria group). A matching of Ninety healthy subjects were included as controls. Blood and urine samples were collected to measure various markers of glycemic control and kidney function. RESULTS IL-18 levels were not changed significantly between all study groups (P > 0.05), despite a significant positive correlation between IL-18 and urinary albumin levels. NGAL levels were significantly increased in Microalbuminuria group and Macroalbuminuria group as compared to the control and Normoalbuminuria groups. NGAL was also positively correlated with urinary albumin and ACR, but negatively correlated with the age and body mass index. Receiver Operating Characteristic curves revealed that for early detection of DN, the best cutoff values to discriminate DN and diabetic without nephropathy groups were ˃ 21.4 ng/ml for NGAL (94.67 sensitivity, 26.67% specificity), ≤0.34 pg/mL for IL-18 (72% sensitivity, 53.33% specificity), and ˃29.8 mg/g for ACR (80% sensitivity, 100% specificity). CONCLUSION We conclude that the urinary ACR is a more accurate individual biomarker of DN when compared to both NGAL and IL-18.
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Affiliation(s)
- Taqwaa Sueud
- Faculty of Medicine, University of Kufa, Al-Najaf, Iraq
| | - Najah R Hadi
- Faculty of Medicine, University of Kufa, Al-Najaf, Iraq
| | | | - Dina A Jamil
- School of Medicine, University of Tasmania, Hobart, TAS, 7000, Australia
| | - Hayder A Al-Aubaidy
- School of Medicine, University of Tasmania, Hobart, TAS, 7000, Australia; School of Life Sciences, La Trobe University, Bundoora, VIC, 3086, Australia.
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Guo L, Zhao Y, Yong Z, Zhao W. Evaluation value of neutrophil gelatinase-associated lipocalin for the renal dysfunction of patients with chronic kidney disease: A meta-analysis. Aging Med (Milton) 2018; 1:185-196. [PMID: 31942496 PMCID: PMC6880667 DOI: 10.1002/agm2.12033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/29/2018] [Accepted: 07/30/2018] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE The role of neutrophil gelatinase-associated lipocalin (NGAL) for the evaluation of renal function in chronic kidney disease (CKD) has not yet to be determined. We aimed to perform a meta-analysis exploring the correlation between NGAL and glomerular filtration rate (GFR) in CKD patients, and to further identify factors affecting NGAL's performance. METHODS Studies dated before November 2017 were retrieved from PubMed, Embase, Web of Science, and the Cochrane Library. A total of 28 relevant studies (involving 3082 patients from 17 countries) were included. The second version of the Quality Assessment for Studies of Diagnostic Accuracy demonstrated that no significant bias had influenced the methodological quality of the included studies. RESULTS Neutrophil gelatinase-associated lipocalin showed a strong negative correlation with measured glomerular filtration rate (mGFR). The pooled correlation coefficient (r) with corresponding 95% confidence intervals for the correlation between serum NGAL (sNGAL) and GFR was -0.48, meanwhile that for urine NGAL (uNGAL) and GFR was -0.34. However, NGAL's performance is different in subgroups restricted by clinical settings, race, sex, age, and staging of renal function. CONCLUSION Neutrophil gelatinase-associated lipocalin could be a renal function evaluation marker for patients with renal dysfunction in CKD. Compared with uNGAL, there was a significant negative correlation between sNGAL and GFR. The performances of sNGAL and uNGAL were restricted by clinical factors that should be considered in regards to the sampling source selection.
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Affiliation(s)
- Lulu Guo
- Division of NephrologyDepartment of Geriatrics of The First Affiliated Hospital with Nanjing Medical UniversityNanjingChina
| | - Yaya Zhao
- Division of NephrologyDepartment of Geriatrics of The First Affiliated Hospital with Nanjing Medical UniversityNanjingChina
| | - Zhenzhu Yong
- Division of NephrologyDepartment of Geriatrics of The First Affiliated Hospital with Nanjing Medical UniversityNanjingChina
| | - Weihong Zhao
- Division of NephrologyDepartment of Geriatrics of The First Affiliated Hospital with Nanjing Medical UniversityNanjingChina
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Markwardt D, Holdt L, Steib C, Benesic A, Bendtsen F, Bernardi M, Moreau R, Teupser D, Wendon J, Nevens F, Trebicka J, Garcia E, Pavesi M, Arroyo V, Gerbes AL. Plasma cystatin C is a predictor of renal dysfunction, acute-on-chronic liver failure, and mortality in patients with acutely decompensated liver cirrhosis. Hepatology 2017; 66:1232-1241. [PMID: 28545169 DOI: 10.1002/hep.29290] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 02/28/2017] [Accepted: 05/20/2017] [Indexed: 12/22/2022]
Abstract
UNLABELLED The development of acute-on-chronic liver failure (ACLF) in patients with liver cirrhosis is associated with high mortality rates. Renal failure is the most significant organ dysfunction that occurs in ACLF. So far there are no biomarkers predicting ACLF. We investigated whether cystatin C (CysC) and neutrophil gelatinase-associated lipocalin (NGAL) can predict development of renal dysfunction (RD), hepatorenal syndrome (HRS), ACLF, and mortality. We determined the plasma levels of CysC and NGAL in 429 patients hospitalized for acute decompensation of cirrhosis in the EASL-CLIF Acute-on-Chronic Liver Failure in Cirrhosis (CANONIC) study. The patients were followed for 90 days. Patients without RD or ACLF at inclusion but with development of either had significantly higher baseline concentrations of CysC and NGAL compared to patients without. CysC, but not NGAL, was found to be predictive of RD (odds ratio, 9.4; 95% confidence interval [CI], 1.8-49.7), HRS (odds ratio, 4.2; 95% CI, 1.2-14.8), and ACLF (odds ratio, 5.9; 95% CI, 1.3-25.9). CysC at day 3 was not found to be a better predictor than baseline CysC. CysC and NGAL were both predictive of 90-day mortality, with hazard ratios for CysC of 3.1 (95% CI, 2.1-4.7) and for NGAL of 1.9 (95% CI, 1.5-2.4). CONCLUSION Baseline CysC is a biomarker of RD, HRS, and ACLF and an independent predictor of mortality in patients with acutely decompensated liver cirrhosis, though determining CysC at day 3 did not provide any benefit; while NGAL is also associated with short-term mortality, it fails to predict development of RD, HRS, and ACLF. Baseline CysC may help to identify patients at risk earlier and improve clinical management. (Hepatology 2017;66:1232-1241).
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Affiliation(s)
- Daniel Markwardt
- Liver Centre Munich, Department of Medicine II, Hospital of the University of Munich, Munich, Germany
| | - Lesca Holdt
- Institute of Laboratory Medicine, Hospital of the University of Munich, Munich, Germany
| | - Christian Steib
- Liver Centre Munich, Department of Medicine II, Hospital of the University of Munich, Munich, Germany
| | - Andreas Benesic
- Liver Centre Munich, Department of Medicine II, Hospital of the University of Munich, Munich, Germany
| | - Flemming Bendtsen
- Gastro Unit, Medical Division, Hvidovre University Hospital, Hvidovre, Denmark
| | - Mauro Bernardi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Richard Moreau
- DHU Unity, Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy; Centre de Recherche sur l'Inflammation CRI, INSERM, CNRS, Université Paris Diderot; and Laboratoire d'Excellence (Labex) Inflammex, COMUE Sorbonne Paris Cité, Paris, France
| | - Daniel Teupser
- Institute of Laboratory Medicine, Hospital of the University of Munich, Munich, Germany
| | | | - Frederik Nevens
- Department of Hepatology, University Hospitals KU Leuven, Leuven, Belgium
| | - Jonel Trebicka
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany.,European Foundation for the Study of Chronic Liver Failure, European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain
| | - Elisabet Garcia
- Data Management Centre, European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain
| | - Marco Pavesi
- Data Management Centre, European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain
| | - Vicente Arroyo
- European Foundation for the Study of Chronic Liver Failure, European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain
| | - Alexander L Gerbes
- Liver Centre Munich, Department of Medicine II, Hospital of the University of Munich, Munich, Germany
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Kandil MA, Abouelenain KM, Alsebaey A, Rashed HS, Afifi MH, Mahmoud MA, Yassen KA. Impact of terlipressin infusion during and after live donor liver transplantation on incidence of acute kidney injury and neutrophil gelatinase-associated lipocalin serum levels: A randomized controlled trial. Clin Transplant 2017. [DOI: https:/doi.org/10.1111/ctr.13019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Mohamed A. Kandil
- Department of Anaesthesia; National Liver Institute; Menoufia University; Shebeen El-Kom Egypt
| | - Khalid M. Abouelenain
- Faculty of Medicine; Department of Anaesthesia; Menoufia University; Shebeen El-Kom Egypt
| | - Ayman Alsebaey
- Department of Hepatology; National Liver Institute; Menoufia University; Shebeen El-Kom Egypt
| | - Hanaa S. Rashed
- Department of Anaesthesia; National Liver Institute; Menoufia University; Shebeen El-Kom Egypt
| | - Mohamed H. Afifi
- Faculty of Medicine; Department of Anaesthesia; Menoufia University; Shebeen El-Kom Egypt
| | - Mohamed A. Mahmoud
- Department of Anaesthesia; National Hepatology and Tropical Medicine Research Institute; Ministry of Health; Shebeen El-Kom Egypt
| | - Khaled A. Yassen
- Department of Anaesthesia; National Liver Institute; Menoufia University; Shebeen El-Kom Egypt
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Kandil MA, Abouelenain KM, Alsebaey A, Rashed HS, Afifi MH, Mahmoud MA, Yassen KA. Impact of terlipressin infusion during and after live donor liver transplantation on incidence of acute kidney injury and neutrophil gelatinase-associated lipocalin serum levels: A randomized controlled trial. Clin Transplant 2017. [DOI: https://doi.org/10.1111/ctr.13019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Mohamed A. Kandil
- Department of Anaesthesia; National Liver Institute; Menoufia University; Shebeen El-Kom Egypt
| | - Khalid M. Abouelenain
- Faculty of Medicine; Department of Anaesthesia; Menoufia University; Shebeen El-Kom Egypt
| | - Ayman Alsebaey
- Department of Hepatology; National Liver Institute; Menoufia University; Shebeen El-Kom Egypt
| | - Hanaa S. Rashed
- Department of Anaesthesia; National Liver Institute; Menoufia University; Shebeen El-Kom Egypt
| | - Mohamed H. Afifi
- Faculty of Medicine; Department of Anaesthesia; Menoufia University; Shebeen El-Kom Egypt
| | - Mohamed A. Mahmoud
- Department of Anaesthesia; National Hepatology and Tropical Medicine Research Institute; Ministry of Health; Shebeen El-Kom Egypt
| | - Khaled A. Yassen
- Department of Anaesthesia; National Liver Institute; Menoufia University; Shebeen El-Kom Egypt
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Urine Interleukin 18 and Lipocalin 2 Are Biomarkers of Acute Tubular Necrosis in Patients With Cirrhosis: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2017; 15:1003-1013.e3. [PMID: 28013112 PMCID: PMC5474196 DOI: 10.1016/j.cgh.2016.11.035] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/02/2016] [Accepted: 11/27/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Acute kidney injury (AKI) is a common complication in patients with cirrhosis that increases mortality. The most common causes of AKI in these patients are prerenal azotemia, acute tubular necrosis (ATN), and hepatorenal syndrome; it is important to determine the etiology of AKI to select the proper treatment and predict patient outcome. Urine biomarkers could be used to differentiate between patients with ATN and functional causes of AKI. We performed a systematic review and meta-analysis of published studies to determine whether urine levels of interleukin (IL)18 and lipocalin 2 or neutrophil gelatinase-associated lipocalin (NGAL) are associated with the development of ATN in patients with cirrhosis. METHODS We searched MEDLINE, Scopus, ISI Web of Knowledge, and conference abstracts through December 31, 2015, for studies that assessed urine biomarkers for detection of acute kidney injury in patients with cirrhosis or reported an association between urine biomarkers and all-cause mortality in these patients. We included only biomarkers assessed in 3 or more independent studies, searching for terms that included urine biomarkers, cirrhosis, NGAL, and IL18. We calculated the pooled sensitivities and specificities for detection and calculated the area under the receiver operating characteristic curve (AUC) values using a bivariate logistic mixed-effects model. We used the χ2 test to assess heterogeneity among studies. RESULTS We analyzed data from 8 prospective studies, comprising 1129 patients with cirrhosis. We found urine levels of the markers discriminated between patients with ATN and other types of kidney impairments, with AUC values of 0.88 for IL18 (95% confidence interval [CI], 0.79-0.97) and 0.89 for NGAL (95% CI, 0.84-0.94). Urine levels of IL18 identified patients who would die in the hospital or within 90 days (short-term mortality) with an AUC value of 0.76 (95% CI, 0.68-0.85); NGAL identified these patients with the same AUC (0.76; 95% CI, 0.71-0.82). CONCLUSIONS In a systematic review and meta-analysis, we found that urine levels of IL18 and NGAL from patients with cirrhosis discriminate between those with ATN and other types of kidney impairments, with AUC values of 0.88 and 0.89, respectively. Urine levels of IL18 and NGAL identified patients with short-term mortality with an AUC value of 0.76. These biomarkers might be used to determine prognosis and select treatments for patients with cirrhosis.
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Kandil MA, Abouelenain KM, Alsebaey A, Rashed HS, Afifi MH, Mahmoud MA, Yassen KA. Impact of terlipressin infusion during and after live donor liver transplantation on incidence of acute kidney injury and neutrophil gelatinase-associated lipocalin serum levels: A randomized controlled trial. Clin Transplant 2017; 31. [PMID: 28564127 DOI: 10.1111/ctr.13019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM Acute kidney injury (AKI) with liver transplantation (LT) is not uncommon. Impact of terlipressin infusion on AKI, hemodynamics, and plasma concentration of neutrophil gelatinase-associated lipocalin (NGAL) was studied. METHODS Patients (n=50) were randomized (NCT02059460, USA) into two equal groups: terlipressin vs Controls. Terlipressin (1-4 μg/kg/h) was administrated for 5 days. Intraoperative transesophageal Doppler for hemodynamic management. Renal functions, peak portal vein blood flow velocity (PPV), and hepatic artery resistive index (HARI) were recorded. Plasma NGAL (pNGAL) was measured baseline, 2 and 24 hours postreperfusion. RESULTS Hepatitis C virus (HCV) was the main etiology. Age, sex, model of end-stage liver disease (MELD), and renal functions were comparable. Postoperative AKI incidence and NGAL concentrations were comparable (P>.05) between terlipressin and controls groups (44% vs 48% and 112.5±9 vs 93.1±8 ng/mL), respectively, but intraoperative NGAL in both groups increased significantly 2 hours postreperfusion (P<.05). The three NGAL readings were comparable (P>.05) between AKI (n=23) and non-AKI developers (n=27). Mean arterial blood pressure (MAP) was maintained in both groups with less systemic vascular resistance (SVR) fluctuations with terlipressin. Median norepinephrine consumption was lower in terlipressin vs controls (8 vs 12 mg; P=.04). The PPV and HARI were not affected by terlipressin at any stage (P>.05). CONCLUSION Postliver transplant AKI was not prevented by terlipressin use nor predicted by NGAL levels.
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Affiliation(s)
- Mohamed A Kandil
- Department of Anaesthesia, National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt
| | - Khalid M Abouelenain
- Faculty of Medicine, Department of Anaesthesia, Menoufia University, Shebeen El-Kom, Egypt
| | - Ayman Alsebaey
- Department of Hepatology, National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt
| | - Hanaa S Rashed
- Department of Anaesthesia, National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt
| | - Mohamed H Afifi
- Faculty of Medicine, Department of Anaesthesia, Menoufia University, Shebeen El-Kom, Egypt
| | - Mohamed A Mahmoud
- Department of Anaesthesia, National Hepatology and Tropical Medicine Research Institute, Ministry of Health, Shebeen El-Kom, Egypt
| | - Khaled A Yassen
- Department of Anaesthesia, National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt
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Hurry PK, Poulsen JH, Bendtsen F, Møller S. Neutrophil gelatinase-associated lipocalin and cystatin C in cirrhosis and portal hypertension: Relations to organ extraction and dysfunction. J Gastroenterol Hepatol 2017; 32:473-481. [PMID: 27435243 DOI: 10.1111/jgh.13492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Early detection of renal dysfunction in cirrhosis is important, and several renal biomarkers have been put forward. Neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C are markers of renal dysfunction, but relations to splanchnic and systemic hemodynamics and kinetics are sparsely studied in cirrhosis. In patients with cirrhosis and portal hypertension, we studied plasma levels and renal, hepatic, and peripheral extraction of NGAL and cystatin C and relations to patients characteristics, liver dysfunction, and hemodynamics. METHODS Forty-five cirrhotic patients (Child class A/B/C:15/15/15) and 15 controls were evaluated with a full clinical, biochemical, and hemodynamic assessment. Urine and regional plasma concentrations of NGAL and cystatin C were measured. RESULTS There was no significant difference in circulating or hepatic NGAL or cystatin C between all patients and controls but a trend towards increased levels with increasing Child class. In addition, there was a significant renal but no hepatic or systemic extraction of both NGAL and cystatin C (P < 0.001). Plasma NGAL correlated with glomerular filtration rate (r = -0.56, P < 0.0001), and hepatic venous pressure gradient (r = 0.34,P = 0.02) and urinary NGAL correlated with heart rate (r = 0.58, P= 0.007), blood pressure (r = -0.46, P < 0.05), cardiac output (r = 0.45, P < 0.05), and systemic vascular resistance (SVR) (r = -0.48, p < 0.05). Plasma cystatin C correlated with hepatic venous pressure gradient (r = 0.45, P < 0.005), blood pressure (-0.40, P < 0.01), and glomerular filtration rate (r = 0.98, P < 0.000). CONCLUSIONS Extractions of NGAL and cystatin C levels seem largely unaffected by the severity of liver disease in cirrhosis with a renal extraction. These biomarkers therefore have the potential of being both valuable in diagnosing renal failure and reflecting the degree of portal hypertension and systemic haemodynamic changes.
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Affiliation(s)
- Preete Kapisha Hurry
- Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging and Research, Hvidovre, Denmark
| | | | - Flemming Bendtsen
- Gastro Unit, Medical Division, Hvidovre Hospital, Faculty of Health Sciences, University of Copenhagen, Hvidovre, Denmark
| | - Søren Møller
- Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging and Research, Hvidovre, Denmark
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Strazzulla A, Coppolino G, Di Fatta C, Giancotti F, D’Onofrio G, Postorino MC, Mazzitelli M, Mammone SV, Gentile I, Rivoli L, Palella E, Gravina T, Costa C, Pisani V, De Maria V, Barreca GS, Marascio N, Focà A, Fuiano G, Gulletta E, Torti C. Is neutrophil gelatinase associated lipocalin useful in hepatitis C virus infection? World J Hepatol 2016; 8:815-824. [PMID: 27429717 PMCID: PMC4937169 DOI: 10.4254/wjh.v8.i19.815] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 04/20/2016] [Accepted: 06/16/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate neutrophil gelatinase associated lipocalin (NGAL) in patients infected by hepatitis C virus (HCV) before and during treatment with directly acting antivirals (DAAs).
METHODS: NGAL was measured in a group of patients with chronic HCV infection ranked, at baseline, by age, gender, anti-hypertensive therapy, HCV viral load, liver fibrosis stage and, either at baseline or after 1 year, estimated glomerular filtration rate (eGFR). Then, NGAL and eGFR evolutions were monitored in a subgroup of patients who started antiviral therapy with DAAs. Differences of median NGAL levels were evaluated through Wilcoxon-Mann-Whitney test for non-parametric data. Differences in dichotomous variables were evaluated through χ2 test. At baseline, a univariate regression analysis was conducted to verify if NGAL values correlated with other quantitative variables [age, fibrosis four (FIB-4), AST to platelet ratio index (APRI), and eGFR].
RESULTS: Overall, 48 patients were enrolled, 8 of them starting HCV treatment. At baseline, statistically significant differences were found in median NGAL values only between patients with eGFR < 60 mL/min vs patients with eGFR ≥ 90 mL/min. Differences in NGAL were not significant among patients ranked by HCV viral load, FIB-4 score and APRI, when patients with NGAL > 118.11 ng/dL were compared with those of NGAL ≤ 118.11 ng/dL, not statistically significant differences were present for age, gender, chronic kidney disease classification and liver fibrosis (P > 0.05). Linear correlation was found between NGAL and both age (P = 0.0475) and eGFR (P = 0.0282) values. Not statistically significant predictions of NGAL at baseline were demonstrated for eGFR evolution 1 year later. Interestingly, in the 8 patients treated with DAAs, median NGAL significantly increased at week 12 compared to baseline (P = 0.0239).
CONCLUSION: Our results suggest that NGAL should be further evaluated as an adjunct marker of kidney function in these patients.
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