The role of urinary NGAL as a diagnostic and prognostic predictor of acute kidney injury in hospitalized decompensated liver cirrhotic patients

• Grant number: 22/14039-5
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: February 01, 2023
• End date: January 31, 2024
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Daniela Ponce
• Grantee: Luiz Felipe de Sousa
• Host Institution: Faculdade de Medicina (FMB). Universidade Estadual Paulista (UNESP). Campus de Botucatu. Botucatu , SP, Brazil

Abstract

INTRODUCTION: Acute kidney injury (AKI) is a frequent complication in decompensated liver disease, contributing to high morbidity and mortality. Serum creatinine is the biomarker of choice within the main criteria for defining and classifying AKI, however, it is influenced by a number of factors that make its analysis inaccurate and late. Therefore, it is necessary to analyze the role of other biomarkers as diagnostic and prognostic predictors of AKI in liver disease. OBJECTIVES: To identify the incidence, risk factors and etiology of AKIs in hospitalized patients with decompensated liver disease, in addition to assessing their impact on the prognosis of these patients. Specific objectives are to evaluate the effectiveness of urinary NGAL as a diagnostic and prognostic predictor of AKI in hospitalized liver disease patients. METHODOLOGY: This is a prospective cohort study, which will evaluate cirrhotic patients admitted to a public university hospital from Dec/2022 to Dec/2023. Cirrhotic patients with CKD stages 4 and 5, in palliative care, kidney transplant recipients and pregnant women, and with inability to collect urine samples, will be excluded. The sample size was calculated, considering that the difference in the urinary value of the biomarkers between the population with and without ARF will be 50 pg/ml, standard deviation of 80 pg/ml, alpha error of 0.05, study power 80%, requiring the inclusion of at least 80 patients. Urine samples will be collected for biomarker dosage within the first 24 hours of hospital admission. The diagnosis of AKI will be performed using the creatinine and urine output criteria established by KDIGO 2012 and CIA. The cutoff value with the best sensitivity and specificity in the ROC curve of the urinary NGAL will be used as a predictor of AKI defined by the KDIGO criteria.Keywords: Acute kidney injury, chronic liver disease, biomarkers, creatinine, NGAL.