Abstract: Objective To investigate the efficacy of serum neutrophil gelatinase associated apolipoprotein (NGAL) and cystatin C （Cys C） in early diagnosis of hepatorenal syndrome（HRS） in patients with acute on chronic liver failure （ACLF）. Methods The clinical data of 204 patients with acute on chronic liver failure in our hospital between January 2010 and January 2017 were retrospectively analyzed,and we found 58 patients having HRS. Serum NGAL,Cys-C, creatinine（Cr）,β2-microglobulin（β2-MG） and urea nitrogen（BUN） were assayed. The diagnostic value of serum parameters in ACLF patients were investigated by the area under the receiver operator characteristic curve （AUROC）. Results The gender,body mass index,course of disease, diabetes,platelet count,blood K⁺,mean arterial pressure were not significantly different between patients with HRS and those without （P>0.05）,while there were obvious differences as respect to the age,hypertension,coronary heart disease,white blood cell count,albumin,proteinuria,blood urea nitrogen, blood Na⁺ and Child-Pugh score between the two groups （P<0.05）;serum NGAL,Cys-C,sCr,β2-MG and BUN levels in patients with HRS were（64.1±18.4） ng/mL,（3.1±1.1） mg/L,（165.8±25.7） μmol/L,（6.3±2.1） mg/L and （12.6±4.3） mmol/L,significantly higher than （11.5±.3） ng/mL,（1.2±0.4） mg/L,（62.6±11.4） μmol/L,（2.7±1.2） mg/L and（4.1±1.5） mmol/L in patients without HRS（P<0.05）;serum parameters of liver functions such as serum bilirubin,and coagulation index in patients with HRS were more severe than those in patients without HRS （P<0.05）;the sensitivity and accuracyof NGAL and Cys-C in diagnosing HRS were 89.6% and 92.1%,and 85.9% and 95.4%,respectively, significantly higher than those by serum Cr,β2-MG or BUN,and the sensitivity and accuracy of combination of NGAL and Cys-C were 92.1% and 96.7%,respectively,also significantly higher than those by NGAL or Cys-C alone. Conclusion The probability of hepatorenal syndrome occurrence in ACLF patients with old age is increasing,and the application of serum NGAL and Cys C in the early diagnosis and prediction of HRS in patients with ACLF is promising, which warrants further clinically observation.

Key words: Acute on chronic liver failure, Hepatorenal syndrome, Neutrophil gelatinase associated apolipoprotein, Cystatin C, Diagnosis