Abstract
BackgroundBiomarkers are potentially useful in assessment of outcomes in patients with cirrhosis, but information is very limited. Given the large number of biomarkers, adequate choice of which biomarker(s) to investigate first is important.AimAnalysis of potential usefulness of a panel of urinary biomarkers in outcome assessment in cirrhosis.Patients and MethodsFifty-five patients with acute decompensation of cirrhosis were studied: 39 had Acute Kidney Injury (AKI) (Prerenal 12, type-1 HRS (hepatorenal syndrome) 15 and Acute Tubular Necrosis (ATN) 12) and 16 acute decompensation without AKI. Thirty-four patients had Acute-on-chronic liver failure (ACLF). A panel of 12 urinary biomarkers was assessed, using a multiplex assay, for their relationship with ATN, ACLF and mortality.ResultsBiomarker with best accuracy for ATN diagnosis was NGAL (neutrophil-gelatinase associated lipocalin): 36 [26-125], 104 [58-208] and 1807 [494-3,716] μg/g creatinine in Prerenal-AKI, type-1 HRS and ATN, respectively; p<0.0001 (AUROC 0.957). Other attractive biomarkers for ATN diagnosis were IL-18, albumin, trefoil-factor-3 (TFF-3) and glutathione-S-transferase-π (GST-π) Biomarkers with less accuracy for ATN AUCROC<0.8 were β2-microglobulin, calbindin, cystatin-C, clusterin and KIM-1 (kidney injury molecule-1). For ACLF, the biomarker with the best accuracy was NGAL (ACLF vs. No-ACLF: 165 [67-676] and 32 [19-40] μg/g creatinine; respectively; p<0.0001; AUROC 0.878). Interestingly, other biomarkers with high accuracy for ACLF were osteopontin, albumin, and TFF-3. Biomarkers with best accuracy for prognosis were those associated with ACLF.ConclusionsA number of biomarkers appear promising for differential diagnosis between ATN and other types of AKI. The most interesting biomarkers for ACLF and prognosis are NGAL, osteopontin, albumin, and TFF-3. These results support the role of major inflammatory reaction in the pathogenesis of ACLF.
Highlights
Biomarkers are important to help in decision making and outcome prediction of chronic conditions
A number of biomarkers appear promising for differential diagnosis between Acute Tubular Necrosis (ATN) and other types of Acute Kidney Injury (AKI)
Because cirrhosis is frequently associated with failure of extrahepatic organs, a condition known as Acute-onchronic liver failure (ACLF), biomarkers of function of organs other than the liver may be of major importance in therapeutic decisions and prediction of prognosis [3,4]
Summary
Biomarkers are important to help in decision making and outcome prediction of chronic conditions. Because cirrhosis is frequently associated with failure of extrahepatic organs, a condition known as Acute-onchronic liver failure (ACLF), biomarkers of function of organs other than the liver may be of major importance in therapeutic decisions and prediction of prognosis [3,4]. In this regard, serum creatinine has been extensively used in the assessment of kidney dysfunction associated with cirrhosis despite its limitations as an estimate of glomerular filtration rate (GFR) [5]. Given the large number of biomarkers, adequate choice of which biomarker(s) to investigate first is important.
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