Abstract: Objective To investigate the diagnostic value of urinary liver fatty acid binding protein (uL-FABP) and urinary kidney injury moleculer-1 (uKIM-1) in hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) patients with acute kidney injury (AKI). Methods A total of 215 patients with HBV-related ACLF admitted to our hospital from October 2014 to May 2017 were enrolled, which were divided into AKI group (n=88) and non-AKI group (n=127). The uL-FABP and uKIM-1 levels were tested by ELISA. The correlations of uL-FABP and uKIM-1 with clinical parameters were analyzed. Diagnostic values of uL-FABP and uKIM-1 for AKI in patients with HBV-related ACLF were evaluated by receiver operating characteristic (ROC) curve. Results The uL-FABP (605.40±276.67 vs. 298.51±108.71 ng/mg, P<0.001) and uKIM-1 (7.90±2.85 vs. 2.89±1.09 ng/mg, P<0.001) levels in AKI group were both significantly higher than those in non-AKI group. In AKI group, the uL-FABP and uKIM-1 levels were both significantly positively associated with white blood cell count, serum creatinine level, model for end-stage liver disease score and AKI stage, while negatively correlated with estimated glomerular filtration rate. In diagnosis of AKI in patients with ACLF, area under the ROC curve (AUC) of uL-FABP was 0.800, AUC of uKIM-1 was 0.793, and AUC of uL-FABP/uKIM-1 combination was 0.836. To distinguish severe AKI (AKI-3) from mild to moderate AKI (AKI-1 and AKI-2), AUCs of uL-FABP, uKIM-1, and uL-FABP/uKIM-1 combination was 0.754, 0.809, and 0.813, respectively. Conclusion The clinical diagnostic values of uL-FABP and uKIM-1 used alone or in combination in patients with HBV-related ACLF were relatively high.

Key words: Acute-on-chronic liver failure, Acute kidney injury, Liver fatty acid binding protein, Kidney injury moleculer-1, Diagnosis