Serum and urinary biomarkers that predict hepatorenal syndrome in patients with advanced cirrhosis

Abstract

Background: Prediction of hepatorenal syndrome (HRS) remains difficult in advanced cirrhotic patients.

Aims: To evaluate use of serum and urine biomarkers to predict HRS.

Methods: We prospectively recruited Child's B or C cirrhotic patients with normal serum creatinine, and followed them for 12 weeks for the development of HRS. Serum Cystatin C (CysC), serum and urine Neutrophil Gelatinase-Associated Lipocalin (NGAL), serum and urine IL-18, serum N-acetyl-β-d glucosaminidase (NAG), urine kidney injury molecule-1 (KIM-1) and urine liver-type fatty acid binding protein (LFABP) were measured at recruitment (baseline), and their relationship with subsequent HRS investigated.

Results: 43 patients were included. 12 (27.9%) developed HRS at 7.3±5.1 weeks from baseline. Logistic regression analysis showed that baseline urinary NGAL and urinary KIM-1 were significantly associated with the development of HRS (RR 1.007, 95% CI 1.001-1.012, p=0.014; RR 1.973, 95% CI 1.002-3.886, p=0.049). The cut-off values for NGAL and KIM-1 to predict HRS were 18.72ng/mL and 1.499ng/mL respectively (AUCs 0.84, p=0.005; and 0.78, p=0.008).

Conclusion: Urinary NGAL and KIM-1 could serve as biomarkers to predict HRS in advanced cirrhotic patients.

Keywords: Advanced cirrhosis; Biomarkers; Hepatorenal syndrome.