Evaluation of Serum Kidney Injury Markers FABP1, NGAL, Cystatin C and the Inflammatory Cytokine IL-18 in the Detection of Acute-on-Chronic Liver Failure (ACLF) Associated Acute Kidney Injury (AKI)

Abstract

Abstract Acute-on-chronic liver failure (ACLF) is a complication of liver cirrhosis which is driven by dysfunctional innate immune activation and multiple organ failure. In ACLF, short-term mortality (28-day mortality) is ~50%. The risk of mortality in ACLF increases significantly with the occurrence of AKI. Hence, early detection and prevention of AKI is a priority for the management of ACLF patients. Here we show, that commonly used serum biomarkers of AKI i.e. FABP1, NGAL and Cystatin C, as well as a marker of inflammation IL-18, are not effective at discriminating between ACLF patients having AKI (ACLF-AKI) and ACLF patients without AKI (ACLF no-AKI). However, IL-18, which is a measure of inflammation, is able to predict mortality in ACLF patients and, Cystatin C is able to discriminate between ACLF-AKI and non-liver AKI. Our results demonstrate that the biomarkers of renal injury which might be effective in other etiologies of AKI may not be effective in early detection of ACLF associated AKI possibly suggesting a different pathomechanism of AKI in ACLF. We anticipate that this study will provide impetus to biomarker discovery studies towards early detection of AKI in ACLF patients.