title: Urinary neutrophil gelatinase-associated lipocalin (NGAL) is associated with mortality in a community-based cohort of older Swedish men.
abstract: OBJECTIVE
  Neutrophil gelatinase-associated lipocalin (NGAL) indicates tubular kidney damage, neutrophil activation and possibly atherogenesis, however the prospective association between urinary NGAL (u-NGAL) and cardiovascular death in the community is not known.
  
  
  METHODS
  This study evaluates the association between urinary and serum NGAL and mortality in a Swedish population of 597 men aged 78 years. During the study (median follow-up 8.1 years) 261 men died, 90 of cardiovascular causes.
  
  
  RESULTS
  U-NGAL was associated with increased all-cause and cardiovascular mortality (HR 2.0 for quartile 4 vs. quartile 1, 95% CI 1.0-4.0, P < 0.05) in Cox regression models independently of cardiovascular risk factors, CRP and cystatin C estimated glomerular filtration rate (eGFRCysC) but not urinary Albumin (u-Alb). A combination of low eGFRCysC (≤60 mL/min), high u-Alb (≥3 mg/mmol Cr) and high u-NGAL (≥1.19 μg/mmol Cr) was associated with a 9-fold increased cardiovascular mortality (P < 0.001) and a 3-fold increased all-cause mortality (P < 0.001). Serum NGAL was associated with increased all-cause mortality risk independent of other cardiovascular risk factors (HR 1.4 for quartile 4 vs.1, 95% CI 1.0-1.9, P < 0.05) but not after adjustment with CRP, eGFRCysC or u-Alb.
  
  
  CONCLUSIONS
  This community study is the first to show that the tubular kidney biomarker u-NGAL associated with increased cardiovascular and all-cause mortality independent of cardiovascular risk factors and glomerular filtration. Additional research is needed to evaluate the utility of NGAL in clinical practice.
authors: Department of Medical Sciences, Uppsala University, Uppsala, Sweden. Johanna.Helmersson_Karlqvist@medsci.uu.se
authors: Johanna
authors: J
authors: Helmersson-Karlqvist
authors: Anders
authors: A
authors: Larsson
authors: Axel C
authors: AC
authors: Carlsson
authors: Per
authors: P
authors: Venge
authors: Johan
authors: J
authors: Sundström
authors: Erik
authors: E
authors: Ingelsson
authors: Lars
authors: L
authors: Lind
authors: Johan
authors: J
authors: Arnlöv
mesh_terms: D000209:Acute-Phase Proteins / Q000652:urine*; D000368:Aged; D050197:Atherosclerosis / Q000378:metabolism / Q000473:pathology; D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality* / Q000652:urine*; D002423:Cause of Death; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000473:pathology; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood* / Q000652:urine*; D008297:Male; D011518:Proto-Oncogene Proteins / Q000097:blood* / Q000652:urine*; D012042:Registries; D012044:Regression Analysis; D012307:Risk Factors; D013548:Sweden; D013997:Time Factors
chemical_list: D000209:Acute-Phase Proteins; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins