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Research Article Open access CC BY 4.0

Neutrophil Gelatinase-Associated Lipocalin (NGAL): An Early Dual Biomarker in Diagnosis of Ascitic Fluid Infection and Acute Kidney Injury in Liver Cirrhosis in a Tertiary Centre, Egypt

Dalia Kamal Nassar, Mohammed Fouad Elkenawy, Mohammed Mahmoud El-Naggar, El-Sayed Abdul-Maksoud Khalil, Ghada Ibrahim Barakat

Journal of Advances in Microbiology · pp. 95–107 · Published 14 Feb 2021

10.9734/jamb/2020/v20i1230313

Abstract

Background: This study aimed to evaluate the ascitic Neutrophil gelatinase-associated lipocalin (NGAL) as a diagnostic biomarker for bacterial translocation or bactDNA translocation in ascites of cirrhotic patients and to evaluate the urinary NGAL for identifying renal dysfunction in patients with liver cirrhosis. Methods: This study included 44 patients with ascites.  Study participants were divided into two groups. Group (1) had 22 patients with neutrocytic ascites and/or positive ascitic fluid (AF) culture while group (2) included 22 patients with culture negative non neutrocytic ascites (CNNNA), recruited as controls. AF and urine samples were collected from all studied participants. ELISA kit was used for measurement of NGAL levels in AF and urine. DNA extraction and PCR were done. Results: Values of NGAL in ascitic fluid were statistically significantly higher in bactDNA positive group. At cutoff 143.9 ng/ml, ascites NGAL had 86.4% sensitivity, 45.5% specificity, 61.3% positive predictive value (PPV) and 76.9% negative predictive value (NPV). When comparing ascites NGAL between bactDNA positive and negative group, NGAL has a sensitivity of 86.2% and a specificity of 46.7%, PPV of 75.8%, NPV of 63.6%. As for urine NGAL, patients with AKI had statistically significant higher levels of NGAL. Urine NGAL achieved sensitivity of 77.3%, specificity of 50%, PPV of 60.7%, NPV of 68.75%. Conclusion: Early and accurate diagnosis of BT or bactDNA translocation  can be aided by utilizing NGAL especially in ruling out infection in those reported to have negative culture results, besides, it can help in early detection of complication of cirrhosis and infection especially AKI helping in the improving the prognosis of cirrhotic patients. It is an advantage that a single marker can detect both infection and kidney injury.

Neutrophil gelatinase-associated lipocalin liver cirrhosis bacterial translocation renal dysfunction.

References (39)

  1. 1 Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document [DOI]
  2. 2 Pathological bacterial translocation in liver cirrhosis [DOI]
  3. 3 The epidemiology of hepatitis C virus in Egypt: a systematic review and data synthesis [DOI]
  4. 4 Spontaneous bacterial peritonitis: recent guidelines and beyond [DOI]
  5. 5 Nonselective β Blockers Increase Risk for Hepatorenal Syndrome and Death in Patients With Cirrhosis and Spontaneous Bacterial Peritonitis [DOI]
  6. 6 Detection and identification of bacterial DNA in patients with cirrhosis and culture-negative, nonneutrocytic ascites [DOI]
  7. 7 Evaluation of standard liver volume formulae for Chinese adults [DOI]
  8. 8 Roles of neutrophil gelatinase-associated lipocalin (NGAL) in human cancer [DOI]
  9. 9 Spontaneous bacterial peritonitis: pathogenesis, diagnosis, treatment.
  10. 10 Emergence of spontaneous bacterial peritonitis due to enterococci – risk factors and outcome in a 12‐year retrospective study [DOI]
  11. 11 Measurement of calprotectin in ascitic fluid to identify elevated polymorphonuclear cell count [DOI]
  12. 12 Does NGAL reduce costs? A cost analysis of urine NGAL (uNGAL) & serum creatinine (sCr) for acute kidney injury (AKI) diagnosis [DOI]
  13. 13 Biomarkers for acute kidney injury in decompensated cirrhosis: A prospective study [DOI]
  14. 14 Procalcitonin and macrophage inflammatory protein-1 beta (MIP-1β) in serum and peritoneal fluid of patients with decompensated cirrhosis and spontaneous bacterial peritonitis [DOI]
  15. 15 Role of biomarkers as predictors of acute kidney injury and mortality in decompensated cirrhosis [DOI]
  16. 16 Bacterial DNA in the diagnosis of spontaneous bacterial peritonitis [DOI]
  17. 17 Ascites Bacterial Burden and Immune Cell Profile Are Associated with Poor Clinical Outcomes in the Absence of Overt Infection [DOI]
  18. 18 Urine neutrophil gelatinase-associated lipocalin: a diagnostic and prognostic marker for acute kidney injury (AKI) in hospitalized cirrhotic patients with AKI-prone conditions [DOI]
  19. 19 To Study the Incidence, Predictive Factors and Clinical Outcome of Spontaneous Bacterial Peritonitis in Patients of Cirrhosis with Ascites [DOI]
  20. 20 Biomarkers of Renal Injury in Cirrhosis: Association with Acute Kidney Injury and Recovery after Liver Transplantation [DOI]
  21. 21 Infection in cirrhosis: A prospective study [DOI]
  22. 22 Assessment and prediction of acute kidney injury in patients with decompensated cirrhosis with serum cystatin C and urine N‐acetyl‐β‐D‐glucosaminidase [DOI]
  23. 23 Association of markers of bacterial translocation with immune activation in decompensated cirrhosis [DOI]
  24. 24 Serum CD64 and ascitic fluid calprotectin and microRNA-155 as potential biomarkers of spontaneous bacterial peritonitis [DOI]
  25. 25 Endothelin-1/Nitric Oxide Ratio as a Predictive Factor of Response to Therapy With Terlipressin and Albumin in Patients With Type-1 Hepatorenal Syndrome [DOI]
  26. 26 Amplification of Bacterial DNA Does Not Distinguish Patients with Ascitic Fluid Infection From Those Colonized by Bacteria [DOI]
  27. 27 Spontaneous bacterial peritonitis detection, treatment and prophylaxis in patients with liver cirrhosis [DOI]
  28. 28 Urinary neutrophil gelatinase-associated lipocalin as a biomarker for the diagnosis of hepatorenal syndrome in cirrhotic patients [DOI]
  29. 29 The Role of Urinary Neutrophil Gelatinase-Associated Lipocalin in Predicting Acute Kidney Dysfunction in Patients With Liver Cirrhosis [DOI]
  30. 30 The diagnostic value of neutrophil gelatinase-associated lipocalin and hepcidin in bacteria translocation of liver cirrhosis.
  31. 31 Comparative Study of Community Acquired and Nosocomial Spontaneous Bacterial Peritonitis and its Variants in 150 Patients [DOI]
  32. 32 Combination of vial culture and broad-range PCR for the diagnosis of spontaneous bacterial peritonitis: experience in a Greek tertiary care hospital [DOI]
  33. 33 Amplification of bacterial genomic DNA from all ascitic fluids with a highly sensitive polymerase chain reaction [DOI]
  34. 34 The value of ascitic neutrophil gelatinase‐associated lipocalin in decompensated liver cirrhosis with spontaneous bacterial peritonitis [DOI]
  35. 35 Detection of molecular bacterascites in decompensated cirrhosis defines a risk with decreased survival [DOI]
  36. 36 The value of ascitic fluid calprotectin and calprotectin-to-albumin ratio in the diagnosis and prognosis of spontaneous bacterial peritonitis [DOI]
  37. 37 The Diagnostic Role of Bacterial DNA in Ascitic Fluid Infection in Patients with Cirrhotic Ascites [DOI]
  38. 38 The role of mean platelet volume in the diagnosis of spontaneous bacterial peritonitis [DOI]
  39. 39 Monocyte Chemotactic Protein-1 Gene Expression in Blood and Ascitic Fluid of Cirrhotic Patients with Spontaneous Bacterial Peritonitis [DOI]

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