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Title: Analysis of a urinary biomarker panel for clinical outcomes assessment in cirrhosis
Author: Ariza Cardenal, Javier
Solà, Elsa
Elia, Chiara
Barreto, Rogelio
Moreira, Rebeca
Morales Ruiz, Manuel
Graupera, Isabel
Rodríguez, Ezequiel
Huelin, Patricia
Solé, Cristina
Fernández, Javier
Jiménez Povedano, Wladimiro
Arroyo, Vicente
Ginès i Gibert, Pere
Keywords: Cirrosi hepàtica
Marcadors bioquímics
Anàlisi d'orina
Malalties del fetge
Hepatic cirrhosis
Biochemical markers
Urine analysis
Liver diseases
Issue Date: 4-Jun-2015
Publisher: Public Library of Science (PLoS)
Abstract: Background Biomarkers are potentially useful in assessment of outcomes in patients with cirrhosis, but information is very limited. Given the large number of biomarkers, adequate choice of which biomarker(s) to investigate first is important. Aim Analysis of potential usefulness of a panel of urinary biomarkers in outcome assessment in cirrhosis. Patients and Methods Fifty-five patients with acute decompensation of cirrhosis were studied: 39 had Acute Kidney Injury (AKI) (Prerenal 12, type-1 HRS (hepatorenal syndrome) 15 and Acute Tubular Necrosis (ATN) 12) and 16 acute decompensation without AKI. Thirty-four patients had Acute-on-chronic liver failure (ACLF). A panel of 12 urinary biomarkers was assessed, using a multiplex assay, for their relationship with ATN, ACLF and mortality. Results Biomarker with best accuracy for ATN diagnosis was NGAL (neutrophil-gelatinase associated lipocalin): 36 [26-125], 104 [58-208] and 1807 [494-3,716] μg/g creatinine in Prerenal-AKI, type-1 HRS and ATN, respectively; p<0.0001 (AUROC 0.957). Other attractive biomarkers for ATN diagnosis were IL-18, albumin, trefoil-factor-3 (TFF-3) and glutathione-S-transferase-π (GST-π) Biomarkers with less accuracy for ATN AUCROC<0.8 were β2-microglobulin, calbindin, cystatin-C, clusterin and KIM-1 (kidney injury molecule-1). For ACLF, the biomarker with the best accuracy was NGAL (ACLF vs. No-ACLF: 165 [67-676] and 32 [19-40] μg/g creatinine; respectively; p<0.0001; AUROC 0.878). Interestingly, other biomarkers with high accuracy for ACLF were osteopontin, albumin, and TFF-3. Biomarkers with best accuracy for prognosis were those associated with ACLF. Conclusions A number of biomarkers appear promising for differential diagnosis between ATN and other types of AKI. The most interesting biomarkers for ACLF and prognosis are NGAL, osteopontin, albumin, and TFF-3. These results support the role of major inflammatory reaction in the pathogenesis of ACLF.
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It is part of: PLoS One, 2015, vol. 10, num. 6, p. 1-14
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ISSN: 1932-6203
Appears in Collections:Articles publicats en revistes (Medicina)

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