The Role of Urinary N-Acetyl-β-d-glucosaminidase in Cirrhotic Patients with Acute Kidney Injury: Multicenter, Prospective Cohort Study.

Jeong‐Ju Yoo ,Hyung Joon Yim,Chang Wook Kim,Jin Mo Yang,Young Seok Kim,Hee Yeon Kim,Ju Hyun Kim,Eun Sun Jang,Soon Woo Nam,Ji Won Park,Bora Lee,Seung Kak Shin,Jin Woo Lee,Sung Won Lee,Young Kul Jung,Sang Gyune Kim,Jung Hyun Kwon,Young Eun Chon,Do Seon Song,Hae Lim Lee,Sook‐Hyang Jeong

doi:10.3390/jcm10194328

Abstract

Background and Aims: Currently, it is difficult to predict the reversibility of renal function and to discriminate renal parenchymal injury in cirrhotic patients with acute kidney injury (AKI). The aim of this study is to evaluate whether urine N-acetyl-β-d-Glucosaminidase (NAG) can predict the survival and response to terlipressin in cirrhotic patients with AKI. Methods: Two hundred sixty-two cirrhotic consecutive patients who developed AKI were prospectively enrolled from 11 tertiary medical centers in Korea between 2016 to 2019. AKI was defined as an increase in serum Cr (SCr) of 0.3 mg/dL or a 50% increase in baseline SCr. Patients diagnosed with hepatorenal syndrome (HRS-AKI) were treated with terlipressin plus albumin. Results: The patients were 58.8 ± 12.9 years old on average and were predominantly male (72.5%). The mean MELD score was 25.3 ± 9.1. When classified according to the AKI phenotype, there were 119 pre-renal, 52 acute tubular necrosis, 18 miscellaneous, and 73 HRS-AKI patients. However, the urine NAG was not effective at discriminating AKI phenotypes, except for HRS-AKI. The baseline urine NAG increased as the baseline AKI stage increased (p < 0.001). In addition, within the same AKI stage, the urine NAG values were significantly lower in the AKI-resolved group than in the unresolved group. The urine NAG level was significantly lower in living patients compared with those who died or who underwent a liver transplant within 3 months (p = 0.005). In the multivariate analysis, the increased urine NAG was a significant risk factor for the 3-month transplant-free survival (TFS) rate, especially in patients with Child–Pugh class ≤ B or MELD < 24. The urine NAG did not predict the response to terlipressin treatment in patients with HRS. Conclusions: Urine NAG is strongly associated with the severity of AKI in patients with liver cirrhosis and is useful for predicting the 3-month TFS.

Highlights

Occurring in 40–50% of hospitalized patients, acute kidney injury (AKI) is a common complication in patients with advanced liver cirrhosis [1,2]
The logistic regression analysis showed that the urine NAG level was not effective at predicting the response to terlipressin in patients with HRS-AKI (Supplementary Table S3). This multicenter, prospective study included more than 200 patients and showed that urine NAG is associated with baseline AKI stage and the short-term prognosis of cirrhotic patients with AKI
Our results indicate that in patients with established AKI, the urinary NAG activity is a useful surrogate for the severity of AKI and that it has prognostic utility

Summary

Introduction

Occurring in 40–50% of hospitalized patients, acute kidney injury (AKI) is a common complication in patients with advanced liver cirrhosis [1,2]. AKI shortens the survival time of patients with liver cirrhosis and is a common cause of mortality [3]. Even stage 1 AKI can be life-threatening in advanced liver cirrhosis. If AKI does not improve during the early stages of cirrhosis, the 3-month mortality rate can reach 32% [5]. It is difficult to predict the reversibility of renal function and to discriminate renal parenchymal injury in cirrhotic patients with acute kidney injury (AKI). The aim of this study is to evaluate whether urine N-acetyl-β-D-Glucosaminidase (NAG) can predict the survival and response to terlipressin in cirrhotic patients with AKI.

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Conclusion