uNGAL IS SUPERIOR THAN SERUM CREATININE AS A DIAGNOSTIC MARKER OF ACUTE KIDNEY INJURY IN CIRRHOTIC PATIENTS

Md. Rofiqul Islam*, Nooruddin Ahmad, S.K.M Nazmul Hasan, Mohammad Nurul Islam Khan, Golam Masud, Md. Abdul Wadud

ABSTRACT

Background: Acute kidney injury (AKI) is known to increase mortality in hospitalized cirrhotic patients; therefore early identification is utmost significance. There are only a few studies evaluating the cut-off level of urine neutrophil gelatinase-associated lipocalin (uNGAL) for diagnosing AKI and its prognostic value in cirrhotic patients. The AKI diagnosis in the early possible period in the hospitalized cirrhotic patients can save many lives. But it is difficult to detect AKI early without conventional biochemical tool, serum creatinine. Objective: The aim of this study was to evaluate uNGAL is superior than serum creatinine as a diagnostic marker of acute in cirrhotic patients. Materials and methods: This cross sectional study was carried out at Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka. A total 70 Patients of decompensated cirrhosis and decompensated cirrhosis with AKI prone conditions admitted into Department of Hepatology in BSMMU were included for the study. They were evaluated by proper history and clinical examination. Initial investigations were done to meet up inclusion and exclusion criteria including liver function test [serum bilirubin (total), serum albumin, prothrombin time (PT)], renal function tests (serum creatinine), ascitic fluid analysis (cytology, total protein, albumin, SAAG), abdominal ultrasonography, CXR-PA view, ECG, echocardiography. Decompensated cirrhosis were diagnosed with a combination of physical, biochemical, radiological and endoscopic findings. The patients were chosen according to purposive sampling. Serum creatinine (sCr) levels 03 months before the admission was collected wherever available and used as baseline sCr. In patients without a previous sCr value, the sCr on admission was used as baseline. Where the baseline sCr was normal then the patients were included for the study. Patients were then monitored with sCr at 24 hours and 48 hours. The presence of AKI was diagnosed when the patients were fulfilled the criteria proposed by the International club of ascites for cirrhotic patient. Urine sample for NGAL was collected within 24 hours after admission. Results: The mean age of the respondents was 43.49±12.46 years and 46.09±14.90 years in Group A and Group B respectively. Twenty-six (74.3%) were male and 9(25.7%) were female in Group A. Twenty-seven (77.1%) were male and 8(22.9%) where female in group B. Male patients were predominant in both groups. Out of 70 cirrhosis patients, HBV was found 45(64.3%) cases, cryptogenic 11(15.7%), NASH 7(10.0%), HCV 5(7.1%) and Wilson’s disease 2(2.9%). Out of 35 acute kidney injury (AKI) patients, the contributing conditions of AKI were hepatic encephalopathy (HE) 8(22.9%), acute on chronic liver failure (ACLF) 7(20.0%), variceal haemorrhage 6(17.1%), spontaneous bacterial peritonitis (SBP) 6(17.1%), pneumonia 2(5.7%). Regarding laboratory parameters platelet count, prothrombin time, INR, serum albumin were statistically difference between two groups. Hb%, TC, ESR, AST, ALT, serum bilirubin, serum ALP were not statistically significant between two groups. Mean serum creatinine were 1.02±0.24 in Group A and 2.27±1.01 in Group B. Comparison of mean uNGAL between Patients of decompensated cirrhosis with AKI and without AKI, uNGAL was significantly higher in AKI group. ROC- AUC of 0.984 (95 % confidence interval [CI]: 0.962–1.000, p < 0.001). The optimal cutoff value was ≥50 ng/mL providing 91.4% sensitivity, 94.3% specificity, 92.8% accuracy, 94.1% positive predictive value (PPV), 91.7% negative predictive value (NPV), respectively. Conclusion: In patients with cirrhosis for early diagnosis and treatment of AKI within possible shortest time the uNGAL is utmost significance Our prospective study indicates that uNGAL is a valid marker for the early detection of AKI in cirrhotic patients with AKI-prone conditions.

Keywords: Microbial Aetiology, phenotypic, genotypic, Acinetobacter.