title: Prognostic value of neutrophil gelatinase-associated lipocalin in acute heart failure.
abstract: BACKGROUND
  The identification of patients at risk for worse outcome is still a challenge. We hypothesized that cystatin C, a marker of renal function, and neutrophil gelatinase-associated lipocalin (NGAL), a marker of acute renal injury, would have a role in the prognostic stratification of these patients.
  
  
  METHODS
  We prospectively evaluated 121 patients admitted for acute HF. Serum NGAL and cystatin C levels were measured on the first morning after admission. The outcome measures used were the occurrence of death from all causes, and the combined endpoint defined as the first occurrence of either death or hospital admission. Patients were followed for up to 3 months.
  
  
  RESULTS
  The variables associated with a higher occurrence of death in a univariate approach were older age and higher levels of BNP, cystatin C and NGAL, and those associated with the occurrence of the combined endpoint were older age, Diabetes mellitus, lower GFR, type 1 cardio-renal syndrome, BNP, cystatin C and NGAL. BNP and NGAL remained independent predictors of the occurrence of both all-cause death and the combined endpoint. NGAL levels in the 75th percentile (>167.5 ng/mL) were associated with a 2.7-fold increase in the risk of death and a 2.9-fold increase in the risk of the first occurrence of either death or hospitalization.
  
  
  CONCLUSIONS
  Serum NGAL, a marker of acute renal injury, is an independent predictor of worse short term prognosis in patients with acute HF. This suggests a role of renal damage, apart from renal function, in the prognosis of these patients.
authors.affiliation: Department of Internal Medicine, Hospital São João, Porto, Portugal. mpalvelos@gmail.com
authors.forename: Margarida
authors.initials: M
authors.lastname: Alvelos
authors.forename: Patrícia
authors.initials: P
authors.lastname: Lourenço
authors.forename: Carla
authors.initials: C
authors.lastname: Dias
authors.forename: Marta
authors.initials: M
authors.lastname: Amorim
authors.forename: Joana
authors.initials: J
authors.lastname: Rema
authors.forename: Ana Bento
authors.initials: AB
authors.lastname: Leite
authors.forename: João Tiago
authors.initials: JT
authors.lastname: Guimarães
authors.forename: Pedro
authors.initials: P
authors.lastname: Almeida
authors.forename: Paulo
authors.initials: P
authors.lastname: Bettencourt
mesh_terms: D000208:Acute Disease; D000209:Acute-Phase Proteins; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis*; D006801:Humans; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000097:blood*
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins