The association between neutrophil gelatinase-associated lipocalin and clinical outcome in chronic heart failure: results from CORONA*.
OBJECTIVE
To study the prognostic value of neutrophil gelatinase-associated lipocalin (NGAL) in chronic heart failure (HF) of ischaemic aetiology.


BACKGROUND
Neutrophil gelatinase-associated lipocalin is a marker of kidney injury as well as matrix degradation and inflammation and has previously been shown to be increased in HF. We investigated whether serum NGAL levels could provide prognostic information in chronic HF.


METHODS
We assessed NGAL as a predictor of primary outcomes (cardiovascular death, nonfatal stroke and nonfatal myocardial infarction, n = 307) and all-cause mortality (n = 321), cardiovascular mortality (n = 259) and hospitalization (n = 647) as well as the number of hospitalizations during follow-up for all (n = 1934) and CV causes (n = 1204) in 1415 patients with chronic HF (≥60 years, New York Heart Association class II-IV, ischaemic systolic HF) in the CORONA population, randomly assigned to 10 mg rosuvastatin or placebo. Results.  Multivariate analysis revealed that NGAL added significant information when adjusting for clinical variables, but was no longer significant when further adjusting for apolipoprotein A-1 (ApoA-1), glomerular filtration rate (GFR), C-reactive protein (CRP) and N-terminal pro-brain natriuretic peptide (NT-proBNP). However, belonging to the highest NGAL tertile was associated with more frequent hospitalization, even after adjusting for clinical variables, GFR and ApoA-1, but not after adjusting for CRP and NT-proBNP. There was no interaction between rosuvastatin treatment and NGAL. Conclusion.  Neutrophil gelatinase-associated lipocalin added no significant information to NT-proBNP and GFR in a multivariate model for primary and secondary end-points.
Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet.
S H
SH
Nymo
T
T
Ueland
E T
ET
Askevold
T H
TH
Flo
J
J
Kjekshus
J
J
Hulthe
J
J
Wikstrand
J
J
McMurray
D J
DJ
Van Veldhuisen
L
L
Gullestad
P
P
Aukrust
A
A
Yndestad
D000209:Acute-Phase Proteins; D000368:Aged; D016632:Apolipoprotein A-I / Q000378:metabolism; D015415:Biomarkers; D002097:C-Reactive Protein / Q000378:metabolism; D002908:Chronic Disease; D005260:Female; D005464:Fluorobenzenes / Q000627:therapeutic use*; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy / Q000378:metabolism; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D009664:Norway; D010359:Patient Readmission / Q000706:statistics & numerical data; D010446:Peptide Fragments / Q000378:metabolism; D011237:Predictive Value of Tests; D011379:Prognosis; D011518:Proto-Oncogene Proteins / Q000097:blood*; D011743:Pyrimidines / Q000627:therapeutic use*; D000068718:Rosuvastatin Calcium; D012720:Severity of Illness Index; D013449:Sulfonamides / Q000627:therapeutic use*
D000209:Acute-Phase Proteins; D016632:Apolipoprotein A-I; D015415:Biomarkers; D005464:Fluorobenzenes; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D010446:Peptide Fragments; D011518:Proto-Oncogene Proteins; D011743:Pyrimidines; D013449:Sulfonamides; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D000068718:Rosuvastatin Calcium; D002097:C-Reactive Protein