Prognosis predictability of serum and urine renal markers in patients with decompensated cirrhosis: A multicentre prospective study

Kim, Tae Hyung; Seo, Yeon Seok; Kang, Seong Hee; Kim, Moon Young; Kim, Sang Gyune; Lee, Hyoyoung; Lee, Jeong-Hoon; Lee, Young‐Sun; Kim, Ji Hoon; Jeong, Soung Won; Jang, Jae Young; Suk, Ki Tae; Jung, Young Kul; An, Hyonggin; Yim, Hyung Joon; Kim, Young Seok; Um, Soon Ho

doi:10.1111/liv.14631

Cited by 14 publications

(17 citation statements)

References 35 publications

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“…Conflicting results have been reported regarding the association between tubular markers and the risk of mortality (105,106,119,(139)(140)(141). In a meta-analysis of five studies, increased urine levels of IL-18 and NGAL identified patients at a higher risk of short-term mortality with an AUC of 0.76 (142).…”

Section: Patient Outcomes and Tubular Injury Markersmentioning

confidence: 99%

Current knowledge about biomarkers of acute kidney injury in liver cirrhosis

Lee

Seo

2022

Clin Mol Hepatol

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Acute kidney injury (AKI) is common in advanced cirrhosis. Prerenal azotemia, hepatorenal syndrome, and acute tubular necrosis are the main causes of AKI in patients with cirrhosis.Evaluation of renal function and differentiation between functional and structural kidney injury are important issues in the management of cirrhosis. However, AKI in cirrhosis exists as a complex clinical spectrum rather than concrete clinical entity. Based on current evidence, changes in serum creatinine (Cr) levels remain the most appropriate standard for defining AKI in cirrhosis. However, serum Cr has a limited role in assessing renal function in this population.This review examines previous studies that investigated the ability of recent biomarkers for AKI in cirrhosis from the perspective of earlier and accurate diagnosis, classification of AKI phenotype, and prediction of clinical outcomes. Serum cystatin C and urine neutrophil gelatinase-associated lipocalin have been extensively studied in cirrhosis, and have facilitated improved diagnosis and prognosis prediction in patients with AKI. In addition, urine N-acetylβ-D-glucosaminidase, interleukin 18, and kidney injury molecule 1 are other promising biomarkers for advanced cirrhosis. However, the clinical significance of these markers remains unclear because there are no cut-off values defining the normal range and differentiating phenotypes of AKI. In addition, AKI has been defined in terms of serum Cr, and renal biopsythe gold standard-has not been carried out in most studies. Further discovery of innovate biomarkers and incorporation of various markers could improve the diagnosis and prognosis prediction of AKI, and will translate into meaningful improvements in patient outcomes.

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Section: Patient Outcomes and Tubular Injury Markersmentioning

confidence: 99%

Current knowledge about biomarkers of acute kidney injury in liver cirrhosis

Lee

Seo

2022

Clin Mol Hepatol

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“…However, combination equations of Cr and cystatin C are superior to sCr[ 64 , 65 ]. Cystatin C is an independent predictor of AKI and outcomes, including mortality[ 67 , 68 ]. Other biomarkers of interest include neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), IL-18, and liver-type fatty acid-binding protein (L-FABP)[ 18 , 59 , 69 ].…”

Section: Novel Biomarkersmentioning

confidence: 99%

“…Urinary NGAL predicted poor outcomes in patients as well[ 67 ]. Kim et al [ 68 ] studied urinary NGAL and cystatin C in 328 decompensated cirrhosis patients (41 patients with AKI). The authors found that urinary NGAL is a predictor of AKI and outcomes (including mortality)[ 68 ].…”

Section: Novel Biomarkersmentioning

confidence: 99%

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Acute kidney injury and hepatorenal syndrome in cirrhosis

Gupta¹,

Bhurwal²,

Law³

et al. 2021

WJG

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Acute kidney injury (AKI) in cirrhosis, including hepatorenal syndrome (HRS), is a common and serious complication in cirrhotic patients, leading to significant morbidity and mortality. AKI is separated into two categories, non-HRS AKI and HRS-AKI. The most recent definition and diagnostic criteria of AKI in cirrhosis and HRS have helped diagnose and prognosticate the disease. The pathophysiology behind non-HRS-AKI and HRS is more complicated than once theorized and involves more processes than just splanchnic vasodilation. The common biomarkers clinicians use to assess kidney injury have significant limitations in cirrhosis patients; novel biomarkers being studied have shown promise but require further studies in clinical settings and animal models. The overall management of non-HRS AKI and HRS-AKI requires a systematic approach. Although pharmacological treatments have shown mortality benefit, the ideal HRS treatment option is liver transplantation with or without simultaneous kidney transplantation. Further research is required to optimize pharmacologic and nonpharmacologic approaches to treatment. This article reviews the current guidelines and recommendations of AKI in cirrhosis.

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“…Research into novel kidney biomarkers is currently in phases 1-3. A few have had prospective assessment (phase 4; neutrophil gelatinase-associated lipocalin [NGAL], (20) CysC, (21)(22)(23) interleukin 18 [IL18], (24,25) liver-type fatty acid-binding protein [L-FABP], (24,25) kidney injury molecule 1 [KIM-1], (24)(25)(26) β-trace protein (25) ), but application in the fifth phase of biomarker discovery, implementation for decision making, is limited.…”

Section: Role Of Novel Biomarkersmentioning

confidence: 99%

Role of Novel Kidney Biomarkers in Patients With Cirrhosis and After Liver Transplantation

et al. 2021

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Acute kidney injury (AKI) and chronic kidney disease (CKD) are important drivers of morbidity and mortality in patients with cirrhosis before and after liver transplantation (LT). In this review, we examine the role of novel kidney biomarkers for early recognition of kidney injury. Studies are limited by lack of reference standards, heterogeneous definitions of outcomes and biomarker cutoffs, and inconsistent diagnostic performance. Overall, a change in biomarker is more relevant than an absolute cutoff. Cystatin C and urinary neutrophil gelatinase‐associated lipocalin (uNGAL) are the most studied candidate biomarkers and identify AKI or progression of AKI earlier than serum creatinine (sCr). Kidney injury molecule 1 and liver‐type fatty acid–binding protein (L‐FABP) also show potential. NGAL and interleukin 18 may play a role in differentiating acute tubular necrosis from other forms of AKI. Combining novel biomarkers with the Model for End‐Stage Liver Disease score may assist prognosis. Persistent elevations in select markers (eg, NGAL) can portend irreversible injury. Several pretransplantation markers (including sCr) predict posttransplantation kidney dysfunction. Pretransplantation assessment of clinical factors (eg, age, diabetes) and novel markers (osteopontin and tissue inhibitor of metalloproteinases 1 [TIMP‐1]) may predict renal kidney recovery after LT. Intraoperative changes in biomarkers predict early post‐LT AKI. Prediction of CKD remains difficult, although a combination of biomarkers (eg, beta‐2 microglobulin, CD40) is promising. Novel biomarkers have yet to replace sCr in guideline‐based evaluation and management of kidney dysfunction in patients with cirrhosis. We propose a theoretical framework for practical incorporation of these biomarkers that considers patient characteristics (risk for irreversible injury), markers of functional and structural change, and assessment of the AKI‐CKD continuum to identify patients at the highest risk for progressive kidney disease before and after LT.

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Prognosis predictability of serum and urine renal markers in patients with decompensated cirrhosis: A multicentre prospective study

Cited by 14 publications

References 35 publications

Current knowledge about biomarkers of acute kidney injury in liver cirrhosis

Current knowledge about biomarkers of acute kidney injury in liver cirrhosis

Acute kidney injury and hepatorenal syndrome in cirrhosis

Role of Novel Kidney Biomarkers in Patients With Cirrhosis and After Liver Transplantation

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