title: Prognostic value of plasma neutrophil gelatinase-associated lipocalin for mortality in patients with heart failure.
abstract: BACKGROUND
  In patients with heart failure, renal dysfunction is associated with a poor outcome. We aimed to assess the prognostic value of plasma neutrophil gelatinase-associated lipocalin (NGAL), a novel marker of renal tubular damage, in patients with heart failure with or without renal dysfunction, and compare it with 2 frequently used biomarkers of chronic kidney disease.
  
  
  RESULTS
  Plasma NGAL, estimated glomerular filtration rate (eGFR), and cystatin C were assessed in 562 patients with heart failure. Chronic kidney disease was defined as eGFR<60 mL/min per 1.73 m2. Outcome was all-cause mortality at 36 months. Mean age was 71±11 years, 61% were men, and 97% were in New York Heart Association functional class II/III. Mean baseline eGFR was 54±20 mL/min per 1.73 m2, mean cystatin C was 11.2 (7.7-16.2) mg/L, and median plasma NGAL was 85 (60-123) ng/mL. Higher plasma NGAL levels were independently associated with an increased risk of all-cause mortality, in patients with and without chronic kidney disease (hazard ratio [per SD increase in log NGAL]=1.45 [1.22-1.72]; P<0.001 and hazard ratio=1.51 [1.06-2.16]; P=0.023, respectively). Similarly, both in patients with high and low cystatin C (median cut-off), higher plasma NGAL levels were independently associated with an increased risk of all-cause mortality. Moreover, when NGAL was entered in the multivariable risk prediction model, eGFR (P=0.616) and cystatin C (P=0.937) were no longer associated with mortality.
  
  
  CONCLUSIONS
  Plasma NGAL predicts mortality in patients with heart failure, both in patients with and without chronic kidney disease and is a stronger predictor for mortality than the established renal function indices eGFR and cystatin C.
authors.affiliation: Department of Cardiology and Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden.
authors.forename: Vincent M
authors.initials: VM
authors.lastname: van Deursen
authors.forename: Kevin
authors.initials: K
authors.lastname: Damman
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.forename: Martje H
authors.initials: MH
authors.lastname: van der Wal
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.forename: Hans L
authors.initials: HL
authors.lastname: Hillege
mesh_terms: D000209:Acute-Phase Proteins; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D055316:Cystatin C / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D006333:Heart Failure / Q000097:blood* / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011518:Proto-Oncogene Proteins / Q000097:blood*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology; D012307:Risk Factors
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D055316:Cystatin C; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins
keywords: NGAL protein, human; heart failure; prognosis