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Clinical utility of urinary neutrophil gelatinase-associated lipocalin and serum cystatin C in a cohort of liver cirrhosis patients with renal dysfunction

a challenge in the diagnosis of hepatorenal syndrome

Gomaa, Salwa H.a; Shamseya, Mohammed M.b; Madkour, Marwa A.b

European Journal of Gastroenterology & Hepatology: June 2019 - Volume 31 - Issue 6 - p 692–702
doi: 10.1097/MEG.0000000000001347
Original Articles: Hepatology
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Objectives This study aimed to assess urinary neutrophil gelatinase-associated lipocalin (uNGAL) and serum cystatin C (sCys C) in liver cirrhosis patients with renal dysfunction and to evaluate their role in the diagnosis of the hepatorenal syndrome (HRS).

Patients and methods Forty-five liver cirrhosis patients were enrolled in the study and they were divided into three groups; the first group included 15 patients with normal renal function, the second group included 15 patients with HRS; and the third group included 15 patients with chronic kidney disease (CKD). There was a fourth group, which included 15 healthy controls. Liver and renal function tests, as well as the estimated glomerular filtration rate were determined. uNGAL was measured using the enzyme-linked immunosorbent assay, and the uNGAL/urinary creatinine concentration (UCC) ratio was calculated. sCys C was measured using the particle-enhanced immunoturbidimetric assay.

Results The ratios of uNGAL and uNGAL/UCC were the highest among HRS patients. The combined uNGAL/UCC ratio and sCys C improved the sensitivity of diagnosis to 93.33% and specificity to 76.67%, with the highest area under the curve of 0.944, 95% confidence interval of 0.879–1.0 (P<0.001). The three biomarkers could successfully identify HRS at the following cutoffs: 84.94 ng/ml, 0.6 ng/mg, and 1.6 mg/l, respectively. Significant positive correlations were found between uNGAL, uNGAL/UCC ratios as well as sCys C and KDIGO stage in liver cirrhosis patients with CKD.

Conclusion uNGAL and a better uNGAL/UCC ratio can be used alone or together with serum cystatin C as early biomarkers for HRS among patients with decompensated liver cirrhosis. Moreover, uNGAL, uNGAL/UCC as well as serum cystatin C could aid the prognostic assessment of cirrhotic patients with CKD.

Departments of aChemical Pathology

bExperimental and Clinical Internal Medicine, Medical Research Institute, University of Alexandria, Alexandria, Egypt

Correspondence to Salwa H. Gomaa, PhD, Department of Chemical Pathology, Medical Research Institute, University of Alexandria, 165 El-Horreya Avenue, El-hadra, Alexandria 21561, Egypt Tel: +20 111 676 3803; fax: +20 34 283 719;e-mail: salwa.hamdi74@yahoo.com

Received August 27, 2018

Accepted December 4, 2018

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