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간경변증 환자의 급성 신부전 발생에 대한 소변 내 호중구 젤라틴 분해효소 연관 리포칼린의 임상적 의의

Clinical Significance of Urinary Neutrophil Gelatinase-associated Lipocalin Levels in Defining the Various Etiologies of Acute Kidney Injury in Liver Cirrhosis Patients

대한소화기학회지 2019년 74권 4호 p.212 ~ 218
이종호 ( Lee Jong-Ho ) - 청주한국병원 소화기내과

윤아일린 ( Yoon Eileen L. ) - 인제대학교 의과대학 상계백병원 내과
박성은 ( Park Seong-Eun ) - 인제대학교 의과대학 상계백병원 내과
박지영 ( Park Ji-Young ) - 인제대학교 의과대학 상계백병원 내과
최정민 ( Choi Jung-Min ) - 인제대학교 의과대학 상계백병원 내과
전태주 ( Jeon Tae-Joo ) - 인제대학교 의과대학 상계백병원 내과
신원창 ( Shin Won-Chang ) - 인제대학교 의과대학 상계백병원 내과
최원충 ( Choi Won Choong ) - 인제대학교 의과대학 상계백병원 내과

Abstract


Background/Aims: A diagnosis of hepatorenal syndrome (HRS) is based on a differential evaluation of acute kidney injury (AKI), which may aggravate the clinical course. This study assessed the clinical significance of the urinary neutrophil gelatinase- associated lipocalin (u-NGAL) levels in a differential diagnosis of AKI in patients with liver cirrhosis (LC).

Methods: Patients with LC who developed AKI were enrolled prospectively. Clinically, patients with AKI were classified into prerenal azotemia (PRA), HRS, and acute tubular necrosis (ATN) groups.

Results:Fifty-five patients (male, 74.5%) with LC who exhibited AKI upon admission were enrolled; 28, 9, and 18 patients were included in the PRA, HRS, and ATN groups, respectively. The baseline model for end-stage liver disease (MELD) scores was similar in the subgroups. The median event creatinine level, measured at the time of the AKI diagnosis, was similar in the HRS and ATN subgroups. On the other hand, the median event u-NGAL level differed significantly between the three subgroups (PRA, HRS, and ATN: 37 vs. 134 vs. 2,625 ng/mL, p=0.003). In particular, the median u-NGAL level of the HRS group was clearly different from those of the PRA (p<0.001) and ATN (p<0.001) groups. Multivariable analysis revealed the natural logarithm of the u-NGAL level (hazard ratio [HR] 1.77, p=0.031) and the MELD score (HR 1.17, p=0.027) to be independent prognostic factors for in-hospital mortality in patients with LC and AKI.

Conclusions: The median u-NGAL level differentiated HRS from ATN and served as a clinical indicator of in-hospital mortality for patients with LC and AKI.

키워드

Lipocalins; Acute kidney injury; Hepatorenal syndrome; Kidney tubular necrosis, acute; Liver cirrhosis
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