Reliability of neutrophil gelatinase-associated lipocalin in detecting acute tubular necrosis in decompensated cirrhosis: Systematic review and meta-analysis.

Background: Acute kidney injury (AKI) in cirrhosis is common. The diagnosis of AKI in cirrhosis patients depends on clinical presentation and laboratory tests like serum creatinine. However, urine biomarkers could also be used to assess the type of AKI and the severity of the disease. We performed a systematic review with meta-analysis to evaluate the association with urine neutrophil gelatinase-associated lipocalin (NGAL) marker in identifying acute tubular necrosis (ATN) in patients with cirrhosis.

Aim: To assess the reliability of urine NGAL in the detection of ATN in patients with cirrhosis.

Methods: We systematically searched MEDLINE and PubMed using keywords including "urine biomarkers", "NGAL", "kidney dysfunction", and "cirrhosis" to identify relevant studies. Data was screened and extracted. Included studies assessed hospitalized cirrhosis patients with AKI using the urine NGAL biomarker. We synthesized the data using diagnostic odds ratio (DOR), comparative and descriptive analyses, and Cochran Mantel-Haenszel (CMH) statistics to evaluate heterogeneity.

Results: Three thousand seven hundred and one patients with cirrhosis were analyzed from a total of 21 cohort studies. The DOR of 14 of those studies [pooled DOR: 22.150, (95%CI: 17.58-27.89), P < 0.0001] demonstrated a significant association between urine NGAL levels and its identification of ATN. Following stratification by cirrhosis status, heterogeneity was analyzed and showed a significant non-zero correlation between NGAL and AKI (CMH statistic = 702.19, P < 0.0001).

Conclusion: In patients with cirrhosis, the use of urine NGAL is a reliable biomarker for detecting ATN and identifying the etiology of AKI.