Prognosis predictability of serum and urine renal markers in patients with decompensated cirrhosis: A multicenter prospective study.

BACKGROUND & AIMS This prospective observational study aimed to evaluate the best serum and urine markers to assess predictability for the prognosis of patients with decompensated cirrhosis. METHODS Serum creatinine and cystatin C (CysC), and urinary N-acetyl-beta-D glucosaminidase (uNAG) and neutrophil gelatinase-associated lipocalin (uNGAL) levels were measured from hospitalized patients with decompensated cirrhosis. RESULTS In total, 328 patients (mean age, 57.2 ± 12.0 years; 237 men) with decompensated cirrhosis were included. Alcoholic liver disease was the most frequent underlying liver disease (68.0%). Acute kidney injury (AKI) was concomitantly present in 41 patients (12.5%) at baseline. INR, serum creatinine and CysC levels, and uNAG and uNGAL levels were significantly higher in patients with AKI. During hospitalization, AKI had progressed in 37 patients (11.3%). In 287 patients without AKI, the incidence of AKI at 3, 6, 9, and 12 months was 15.4%, 22.2%, 28.6%, and 32.5%, respectively. On multivariate analysis, serum CysC and uNAG levels were independent predictors of AKI, and their optimal cutoff values were 1.055 mg/L and 23.1 U/g urinary Cr, respectively. When patients were classified into three groups with these cutoff values of serum CysC and uNAG levels (group 1, both low; group 2, one of two high; and group 3, both high), progression of AKI during hospitalization (P=0.001), incidence of AKI in patients without AKI at baseline (P=0.001), and mortality rate (P<0.001) differed significantly according to serum CysC and uNAG levels. CONCLUSION Serum CysC and uNAG levels are useful prognostic markers for renal outcomes and mortality in patients with decompensated cirrhosis.