UNGAL may aid in predicting mortality in acute kidney injury

WASHINGTON — Assessing cirrhotic patients for urine neutrophil gelatinase-associated lipocalin at hospital admission may predict mortality associated with acute kidney injury, according to findings presented here.

Veeravich Jaruvongvancih, MD, of the department of medicine at Chulalongkorn University in Bangkok, said that few studies have investigated cutoff levels for urine neutrophil gelatinase-associated lipocalin (UNGAL) for detecting acute kidney injury in patients with cirrhosis.

“Severity of renal injury is associated with mortality,” Jaruvongvancih said. “Prompt diagnosis of acute kidney injury can reduce mortality.”

The current prospective cohort study included 121 cirrhotic patients accrued at a single center in Thailand during May 1, 2011 through Dec. 31, 2013. Eligible participants were at high risk for acute kidney injury with conditions including volume depletion, bacterial infection, nephrotoxic agent exposure and cirrhotic-related acute decompensated conditions.

The final analysis included 86 patients without acute kidney injury and 35 patients with acute kidney injury.

Clinicians obtained UNGAL levels with the Architect analyzer (Abbott Diagnostics) within 24 hours of hospital admission and then measured serum creatinine over a 3-day period. They defined acute kidney injury as an increase of 0.3 mg/dL or of 50% in serum creatinine from baseline within the first 48 hours.

Jaruvongvancih reported that at baseline, the mean meld score was 14.9 ± 5.7, while the serum creatinine level was 0.88 ± 0.29 mg/dL.

Within 72 hours of hospital admission, 29% of the cohort developed acute kidney injury. Prerenal azotemia was the diagnosis in 68.6% of these patients, while 25.7% had intrinsic acute kidney injury and 5.7% had hepatorenal syndrome.

Patients who developed acute kidney injury had a mean UNGAL level of 290.6 ng/mL, compared with 54.4 ng/mL for those who did not develop acute kidney injury (P < .001).

Jaruvongvancih reported an area under the curve for UNGAL level for the diagnosis of acute kidney injury of 0.83 (95% CI, 0.76-0.91).

From these results, the researchers determined that the optimal cut-off level for UNGAL in this patient population was 56 ng/mL. This level yielded a sensitivity of 77.1%, a specificity of 73.3%, a positive predictive value of 54% and a negative predictive value of 88.7%.

Other findings indicated that the mortality rate at 30 days was 14%. While only 40.4% of the cohort reached 180 days follow up, the mortality rate increased to 19% by that time point. Mean UNGAL levels were 217.7 ng/mL in the 30-day mortality group, compared with 107.2 ng/mL among survivors (P = .03). Similarly, 180-day UNGAL levels were 172.6 ng/mL in the mortality group and 84.5 ng/mL among survivors (P = .04).

“Measuring UNGAL within 24 hours after hospital admission is a good diagnostic tool for acute kidney injury in cirrhotic patients with AKI-prone conditions,” Jaruvongvancih said. – by Rob Volansky

For more information:

Treeprasertsuk S, et al. Abstract 590. Presented at: Digestive Disease Week; May 16-19, 2015; Washington, D.C.

Disclosure: Jaruvongvancih reports no relevant financial disclosures. Please see the DDW faculty disclosure index for all other researchers’ relevant financial disclosures.