Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 27, 2024; 16(11): 1331-1338
Published online Nov 27, 2024. doi: 10.4254/wjh.v16.i11.1331
Reliability of neutrophil gelatinase-associated lipocalin in detecting acute tubular necrosis in decompensated cirrhosis: Systematic review and meta-analysis
Nirav Agrawal, Scarlet Louis-Jean, Zoya Ladiwala, Harsha Adnani, Ayesha Kamal, Mitchell Karpman, Albert Steven Fleisher, Sanmeet Singh
Nirav Agrawal, Scarlet Louis-Jean, Zoya Ladiwala, Harsha Adnani, Ayesha Kamal, Department of Internal Medicine, Anne Arundel Medical Center, Annapolis, MD 21401, United States
Mitchell Karpman, Department of Biostatistics, Anne Arundel Medical Center, Annapolis, MD 21401, United States
Albert Steven Fleisher, Sanmeet Singh, Department of Gastroenterology, Anne Arundel Medical Center, Annapolis, MD 21401, United States
Author contributions: Agrawal N, Ladiwala Z, Adnani H, Kamal A, created the project concept, Ladiwala Z, Adnani H, Kamal A, helped with data extraction and data synthesis. Agrawal N, Louis-Jean S and Karpman M, helped with the data analysis and data interpretation. Louis-Jean S and Agrawal N helped writing the manuscript. Fleisher SA, and Singh S were mentors helping in each step of the process and guidance.
Conflict-of-interest statement: There are no conflict of interest to declare for this paper.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nirav Agrawal, MBBS, MD, Researcher, Department of Internal Medicine, Anne Arundel Medical Center, 2001 Medical Parkway, Annapolis, MD 21401, United States. nirav1191@gmail.com
Received: July 28, 2024
Revised: September 1, 2024
Accepted: October 8, 2024
Published online: November 27, 2024
Processing time: 100 Days and 18 Hours
Abstract
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.

Keywords: Neutrophil gelatinase-associated lipocalin; Acute tubular necrosis; Acute kidney injury; Cirrhosis; Biomarker; Severe liver dysfunction

Core Tip: The findings of this systematic review and meta-analysis supports that neutrophil gelatinase-associated lipocalin (NGAL) can reliably predict acute tubular necrosis (ATN) among patients with decompensated cirrhosis. 2. The pooled diagnostic odds ratio of 22.15 (95%CI: 17.58-27.89) from 14 studies indicates a strong correlation between high urinary NGAL levels and the presence of ATN in cirrhosis patients with acute kidney injury.