Plasma neutrophil gelatinase-associated lipocalin for the prediction of acute kidney injury in acute heart failure.
BACKGROUND
The accurate prediction of acute kidney injury (AKI) in patients with acute heart failure (AHF) is an unmet clinical need. Neutrophil gelatinase-associated lipocalin (NGAL) is a novel sensitive and specific marker of AKI.


METHODS
A total of 207 consecutive patients presenting to the emergency department with AHF were enrolled. Plasma NGAL was measured in a blinded fashion at presentation and serially thereafter. The potential of plasma NGAL levels to predict AKI was assessed as the primary endpoint. We defined AKI according to the AKI Network classification.


RESULTS
Overall 60 patients (29%) experienced AKI. These patients were more likely to suffer from pre-existing chronic cardiac or kidney disease. At presentation, creatinine (median 140 (interquartile range (IQR), 91 to 203) umol/L versus 97 (76 to 132) umol/L, P<0.01) and NGAL (114.5 (IQR, 67.1 to 201.5) ng/ml versus 74.5 (60 to 113.9) ng/ml, P<0.01) levels were significantly higher in AKI compared to non-AKI patients. The prognostic accuracy for measurements obtained at presentation, as quantified by the area under the receiver operating characteristic curve was mediocre and comparable for the two markers (creatinine 0.69; 95%CI 0.59 to 0.79 versus NGAL 0.67; 95%CI 0.57 to 0.77). Serial measurements of NGAL did not further increase the prognostic accuracy for AKI. Creatinine, but not NGAL, remained an independent predictor of AKI (hazard ratio (HR) 1.12; 95%CI 1.00 to 1.25; P=0.04) in multivariable regression analysis.


CONCLUSIONS
Plasma NGAL levels do not adequately predict AKI in patients with AHF.
Department of Internal Medicine, University Hospital Basel, Peterplatz 1, Basel, 4003, Switzerland. breidthardtt@uhbs.ch
Tobias
T
Breidthardt
Thenral
T
Socrates
Beatrice
B
Drexler
Markus
M
Noveanu
Corinna
C
Heinisch
Nisha
N
Arenja
Theresia
T
Klima
Christina
C
Züsli
Tobias
T
Reichlin
Mihael
M
Potocki
Raphael
R
Twerenbold
Jürg
J
Steiger
Christian
C
Mueller
D000208:Acute Disease; D058186:Acute Kidney Injury / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D000209:Acute-Phase Proteins; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000097:blood*
D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins