The use of urinary kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin for diagnosis of hepato-renal syndrome in advanced cirrhotic patients

Figures & data

Table 1. Baseline characteristics of the studied groups.

	All patients (n = 88)	Group 1 Patients without HRS (n = 44)	Group 2 Patients with HRS (n = 44)	p Value
Sex M/F	43/ 45	18/ 26	25/ 19	0.135
Age (years)	60.4 (9.9)	59.3 (10.1)	61.6 (9.9)	0.293
Weight (Kg)	78.2 (11.5)	76.5 (11.2)	79.8 (11.7)	0.176
Baseline Heart Rate (/ min)*	72	77	71	0.342
Baseline WBCs (cells/ mm^3)	5100	4690	5650	0.473
Baseline s. creatinine (mg/ dL)*	1.36	0.9	2.85	0.001**
Baseline blood urea (mg/ dL)*	70	50	99.5	0.001**
eGFR (mL/min)*	49.9	82.5	23.1	0.001**
Baseline Na (mEq/L)	130.0 (5.2)	130.5 (5.7)	129.6 (4.6)	0.445
Baseline K (mEq/L)*	4	3.5	5.3	0.001**
Baseline AST (Units/L)* (normal range is 8 to 33 Units/L)	65.5	50.5	85	0.001**
Baseline ALT (Units/L) (normal range is 4 to 36 Units/L)	45.3 (16.6)	38.1 (9.8)	52.4 (18.9)	0.001**
Baseline total bilirubin (mg/ dL)*	2.1	1.9	2.1	0.399
Baseline s. albumin (g/dL)	2.9 (0.6)	3.1 (0.7)	2.8 (0.6)	0.062
Baseline INR*	1.6	1.5	1.7	0.009**
Etiology of liver cirrhosis:				0.336
HCV	82	42	40
Bilharzial	2	0	2
Budd Chiari	1	1	0
Unidentified	3	1	2
Ascites by ultrasound:				0.816
Nil	7	4	3***
Mild	30	15	15
Moderate	38	20	18
Tense	13	5	8
Spleen by ultrasound:				0.952
Normal	30	15	15
Splenectomy	13	6	7
Splenomegaly	45	23	22

n: number; P: probability value; HRS: hepatorenal syndrome; M/F: male/female; KG: kilogram; min: minute; cells/mm³: cells per cubic millimeter; mg/dL: milligrams per deciliter; eGFR: estimated glomerular filtration rate; mL/min: milliliter per minute; Na: sodium; mEq/L: milliequivalents per liter; K: potassium; AST: aspartate aminotransferase; Units/L: units/Liter; ALT: alanine transaminase; s: albumin = serum bilirubin; g/dL: gram per deciliter; INR: international normalized ratio; HCV: hepatitis C.

* : not normally distributed variables,.

** : statistically significant difference.

*** These cases presented clinically with ascites, but they had ultrasound done late after repeated paracentesis as they presented with respiratory distress and were in need for urgent paracentesis. Paracentesis was done blindly without imaging guidance.

Table 2. . Different levels of U-NGAL and U-KIM-1 in groups 1 and 2.

	All patients (N = 88)	Group 1 Patients without HRS (n = 44)	Group 2 Patients with HRS (n = 44)	p Value
Urinary KIM-1(ng/mL)*	0.03 − 3.39 (0.61)	0.48 − 3.38 (0.89)	0.03 − 3.39 (1.4)	0.282
Min – max (median)
Urinary N-GAL (ng/mL)* Min – max (median)	0.04 − 2.70 (1.63)	0.45 − 2.37 (1.53)	0.04 − 2.70 (1.77)	0.104

* not normally distributed variables.

Figure 1. Predictive margins for Urinary KIM-1 and HRS with 95% confidence intervals. The increasing levels of Urinary KIM-1 were not associated with an increasing probability of HRS in the univariate analysis.

Figure 2. Predictive margins for Urinary NGAL and HRS with 95% confidence intervals. The increasing levels of Urinary NGAL were not associated with an increasing probability of HRS in the univariate analysis.

Figure 3. shows the receiver operating curve (ROC) for the sensitivity and specificity of Urinary KIM-1 for the prediction of the occurrence of HRS. At the level of 2.4 ng/mL (the 75th percentile), the area under curve was 0.88. Specificity and sensitivity were 61.1% and 52.9%, respectively at the same level.

Table 3. Association between urinary KIM-1 and NGAL and the presence of HRS.

	Univariate analysis			Multivariate analysis
	OR	95% CI	p	OR	95% CI	p
Urinary KIM-1	1.422	0.923 − 2.191	0.110	2.204	1.101 − 4.415	0.026**
Urinary NGAL	1.735	0.817 − 3.686	0.152	2.913	0.838 − 10.124	0.093

Multivariate analysis adjusted for gender, bilirubin, albumin, INR, K, AST, ALT.

Table 4. Estimation of the cutoff value of U-KIM-1 in patients with HRS.

	Cutoff value	AUC	Sensitivity	Specificity	Positive predictive value	Negative predictive value
Urinary KIM-1	2.40	0.888	61.1 %	52.9 %	25 %	84.1 %