Role of Urinary Neutrophil Gelatinase Associated Lipocalin (NGAL) in various types of hepatorenal syndrome (HRS) based on New definition

Abstract

Background and Aim: Hepatorenal syndrome in cirrhosis is known for many years. Recently definition and subgroup of the hepatorenal syndrome had been updated. So, we conducted this study to evaluate the role of neutrophil gelatinase-associated lipocalin (NGAL) in a group of patients divided based on a new definition. Methods: We have enrolled 62 consecutive patients with cirrhosis with HRS based on new criteria given by Angeli et al.'s in their position paper. Patients were also subcategorized into three groups- HRS- AKI, HRS-AKD, and HRS-CKD. Urinary NGAL was measured on Day 3 of admission Results: Among 62 patients, the majority of patients were having HRS-AKI (49 patients, 79%). While 8 patients and 5 patients were having HRS-AKD and HRS-CKD. Urinary neutrophil gelatinase-associated lipocalin (NGAL) was higher in HRS-AKI than in HRS-AKD and HRS-CKD (Median- 463.6 vs 212.2 vs 53 drug/L respectively). Also, urinary NGAL was significantly higher in patients with persistent AKI (18 patients) than transient AKI (31 patients) (421 ± 322 vs 267 ± 188 drug/L). Overall mortality in the HRS-AKI group was 35.7% (31/49 patients). Urinary NGAL level in deceased patients with HRS-AKI was significantly higher than in survived patients (521 345 vs 260 ± 170 drug/L, p-value- 0.04). Conclusions: NGAL measured on day 3 is an important predictor of renal outcome and survival in patients with cirrhosis.