Introduction: Acute kidney injury is associated with increased mortality in hospitalized cirrhotic patients;
therefore early and accurate diagnosis is crucial. The prognosis of AKI in cirrhosis depends on its specific
aetiology which remains a challenge.
Aim: We aimed to determine the accuracy of urinary Neutrophil Gelatinase-Associated Lipocalin (uNGAL) for
diagnosis, differentiation of the various aetiologies of AKI in cirrhotics and to evaluate its value in short term
prognosis.
Methods: Eighty-two cirrhotic patients were investigated for uNGAL during hospital admission and AKI types
were determined blinded to uNGAL measurements. Patients were followed up till discharge.
Results: Patients with liver cirrhosis and renal impairment (n= 62) had significantly higher levels of uNGAL
(102.4 ±100 ng/ml) when compared with patients with cirrhotics with normal kidney function (n= 20) (102.4
±100 vs 17.4±14.71 ng/ml). Patients with acute tubular necrosis (ATN) had significantly higher uNGAL
(189.2±124 ng/ml) compared to other aetiologies, while prerenal azotemia had the lowest value (46.1±39.9
ng/ml). UNGAL levels were significantly higher in the mortality group of patients (p=0.006) and in patients
admitted to ICU (p<0.001) than the survivors and patient without ICU admission respectively. The AUC of
uNGAL for diagnosis of AKI was 0.892 with a cutoff > 33 ng/ml providing specificity 90% and sensitivity 79%.
In multivariate regression analysis, uNGAL was highly significant independent predictor of inpatient cirrhosis
relayed mortality.
Conclusion: UNGAL is a promising biomarker for diagnosis of AKI and differentiation between its different
aetiologies in cirrhosis including ATN, HRS and pre renal azotemia. UNGAL can independently predict poor
short term prognosis.