Neutrophil gelatinase-associated lipocalin predicts the efficacy of tolvaptan for ascites in patients with liver cirrhosis.
Acute kidney injury
Liver cirrhosis
Neutrophil gelatinase-associated lipocalin
Tolvaptan
Water retention
Journal
Journal of gastroenterology
ISSN: 1435-5922
Titre abrégé: J Gastroenterol
Pays: Japan
ID NLM: 9430794
Informations de publication
Date de publication:
07 2023
07 2023
Historique:
received:
31
01
2023
accepted:
08
04
2023
medline:
30
6
2023
pubmed:
27
4
2023
entrez:
27
4
2023
Statut:
ppublish
Résumé
Acute kidney injury (AKI) is associated with liver cirrhosis (LC), water retention, diuretics to treat water retention, and a poor prognosis. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) reportedly predicts a poor prognosis in decompensated LC. This study investigated the usefulness of uNGAL in predicting the short- and long-term effects of tolvaptan (TVP) and the incidence of AKI post-TVP administration. Of the LC cases with water retention, 86 with available pre-treatment uNGAL were analyzed. A short-term response was defined as weight loss of ≥ 1.5 kg within the first week; a long-term response was defined as a short-term response without early recurrence. The uNGAL usefulness in predicting the short- and long-term effects of TVP and AKI incidence post-TVP administration was investigated. Short-term effects of TVP were observed in 52 patients. Of these, 15 patients had an early recurrence. In multivariate analysis, significant short-term predictive factors were C-reactive protein (CRP) < 1.4 mg/dl, uNa/K ratio ≥ 3.51, and uNGAL < 50.2 ng/ml. Patients were classified according to these three cut-off values, with short-term response rates of 92.9%, 68.8%, 26.7%, and 0% for 0, 1, 2, and 3 points, respectively. CRP < 0.94 mg/dl and uNGAL < 50.2 ng/ml were significant factors for predicting the long-term response of TVP. The AKI incidence post-TVP was 8.1% (n = 7) and was significantly higher among those with uNGAL ≥ 38.1 ng/mL. uNGAL is a useful predictor of the short- and long-term efficacy of TVP and can be useful in predicting AKI incidence post-TVP administration.
Sections du résumé
BACKGROUND
Acute kidney injury (AKI) is associated with liver cirrhosis (LC), water retention, diuretics to treat water retention, and a poor prognosis. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) reportedly predicts a poor prognosis in decompensated LC. This study investigated the usefulness of uNGAL in predicting the short- and long-term effects of tolvaptan (TVP) and the incidence of AKI post-TVP administration.
METHODS
Of the LC cases with water retention, 86 with available pre-treatment uNGAL were analyzed. A short-term response was defined as weight loss of ≥ 1.5 kg within the first week; a long-term response was defined as a short-term response without early recurrence. The uNGAL usefulness in predicting the short- and long-term effects of TVP and AKI incidence post-TVP administration was investigated.
RESULTS
Short-term effects of TVP were observed in 52 patients. Of these, 15 patients had an early recurrence. In multivariate analysis, significant short-term predictive factors were C-reactive protein (CRP) < 1.4 mg/dl, uNa/K ratio ≥ 3.51, and uNGAL < 50.2 ng/ml. Patients were classified according to these three cut-off values, with short-term response rates of 92.9%, 68.8%, 26.7%, and 0% for 0, 1, 2, and 3 points, respectively. CRP < 0.94 mg/dl and uNGAL < 50.2 ng/ml were significant factors for predicting the long-term response of TVP. The AKI incidence post-TVP was 8.1% (n = 7) and was significantly higher among those with uNGAL ≥ 38.1 ng/mL.
CONCLUSION
uNGAL is a useful predictor of the short- and long-term efficacy of TVP and can be useful in predicting AKI incidence post-TVP administration.
Identifiants
pubmed: 37103575
doi: 10.1007/s00535-023-01993-w
pii: 10.1007/s00535-023-01993-w
doi:
Substances chimiques
Lipocalin-2
0
Tolvaptan
21G72T1950
Acute-Phase Proteins
0
Lipocalins
0
Proto-Oncogene Proteins
0
Biomarkers
0
C-Reactive Protein
9007-41-4
Water
059QF0KO0R
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
656-667Subventions
Organisme : Japan Agency for Medical Research and Development
ID : (JP21fk0310103
Organisme : Japan Agency for Medical Research and Development
ID : JP21fk0210053
Organisme : Japan Agency for Medical Research and Development
ID : JP21fk0210072
Organisme : Japan Agency for Medical Research and Development
ID : JP20fk0210056
Organisme : Japan Agency for Medical Research and Development
ID : JP21fk0310101
Organisme : Japan Agency for Medical Research and Development
ID : JP21fk0210047
Organisme : Japan Agency for Medical Research and Development
ID : JP21fk0210064
Organisme : Japan Agency for Medical Research and Development
ID : JP21fk0210056
Organisme : Japan Agency for Medical Research and Development
ID : JP21fk0210048
Organisme : Japan Agency for Medical Research and Development
ID : JP21fk0210058
Organisme : Japan Agency for Medical Research and Development
ID : JP21fk0210066
Organisme : Japan Agency for Medical Research and Development
ID : 21fk0210067
Organisme : Japan Society for the Promotion of Science
ID : JP20K08371
Organisme : Japan Society for the Promotion of Science
ID : JP22K15954
Informations de copyright
© 2023. Japanese Society of Gastroenterology.
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