Role of Serum Angiopoietin-2 in Prediction of Mortality in Cirrhotic Patients with Acute Kidney Injury

Abstract

Background and study aim: This study aims to investigate the potential of serum Angiopoietin-2 (S. Ang-2) levels as an early indicator for acute kidney injury (AKI) and all-cause mortality in patients with cirrhosis. AKI poses a significant risk to cirrhotic patients, particularly in a decompensated state, and has implications for morbidity and mortality, often with a limited treatment window. Angiopoietin-2 (Ang-2), is a proinflammatory marker associated with endothelial injury, contributes to increased vascular permeability and inflammation by antagonizing the tyrosine kinase with Ig and epidermal growth factor (EGF) homology domains (Tie2) receptor. Patients and Methods: This cross-sectional study included 90 cirrhotic patients divided into three groups: G I (30 compensated cirrhotic patients), G II (30 decompensated cirrhotic patients without AKI), and G III (30 decompensated cirrhotic patients with AKI). Enzyme-linked immunoassay (ELISA) was used to measure serum Ang-2 levels. Clinical characteristics and outcomes were evaluated and correlated with S. Ang-2 levels and Model for End-Stage Liver Disease (MELD) Score during hospitalization. Results: The average S. Ang-2 level was 1463.89±943.24, with the highest levels observed in G III (2530.67±151.14), and an average MELD score of 15.44±8.48 (range: 6.00-39.00). A positive correlation was found between higher MELD scores and elevated S. Ang-2 levels. S. Ang-2 demonstrated promising early detection capabilities for mortality, with a sensitivity of 95% and specificity of 90% using a cutoff value of >2325 ng/ml. Univariate and multivariate regression models were employed to determine the predictive value of S. Ang-2 for mortality, with a 95% confidence interval. Conclusion: S. Ang-2 levels showed a strong correlation with mortality and other clinically relevant outcomes in a cohort of cirrhotic patients with AKI. Significant correlations were also observed between S. Ang-2 levels and complications such as hepatorenal syndrome (HRS), hepatocellular carcinoma (HCC), and hepatic encephalopathy (HE).