Admission plasma neutrophil gelatinase associated lipocalin (NGAL) predicts worsening renal function during hospitalization and post discharge outcome in patients with acute heart failure.
Abstract Background: The role of neutrophil gelatinase-associated lipocalin (NGAL) has been described in chronic heart failure (HF), however less data are available in patients admitted for acute HF.


METHODS
We evaluated the role of NGAL in predicting in-hospital worsening renal function (WRF) and post-discharge follow-up during six months period in patients with acute HF. All patients were submitted to creatinine, estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN) and B-type natriuretic peptide (BNP) measurement during hospitalization and before discharge.


RESULTS
Patients with chronic kidney dysfunction (CKD) demonstrated higher NGAL respect to subject with preserved renal function (241 ± 218 and 130 ± 80 ng/ml; P = 0.0001). In subgroup that developed WRF during hospitalization, NGAL levels were significantly increased respect to patients without WRF (272 ± 205 versus 136 ± 127 ng/ml; P = 0.0001). A cut off of 134 ng/ml has been related to WRF with good sensibility and specificity (92% and 71% AUC 0.83; P = 0.001). Multivariable Cox regression analysis showed that cut-off of 134 ng/ml was the only marker related to death (HR: 1.75; 95% CI: 1.24-2.45; P < 0.001). Follow-up analysis confirmed that NGAL > 130 ng/ml was associated with adverse events during a six-month period.


CONCLUSIONS
Admission NGAL measurement appears a sensible tool for in-hospital WRF prediction as well as an early marker for adverse outcome during post discharge vulnerable phase.
Department of Internal Medicine, UOS Cardiology, Le Scotte Hospital, University of Siena , Italy.
Alberto
A
Palazzuoli
Gaetano
G
Ruocco
Matteo
M
Beltrami
Beatrice
B
Franci
Marco
M
Pellegrini
Barbara
B
Lucani
Ranuccio
R
Nuti
Claudio
C
Ronco
D000208:Acute Disease; D000209:Acute-Phase Proteins; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001806:Blood Urea Nitrogen; D059347:Cardio-Renal Syndrome / Q000175:diagnosis / Q000503:physiopathology; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000097:blood / Q000401:mortality / Q000503:physiopathology*; D006760:Hospitalization; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood*; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010359:Patient Readmission; D010865:Pilot Projects; D011379:Prognosis; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000097:blood*; D012044:Regression Analysis
D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D020097:Natriuretic Peptide, Brain; D003404:Creatinine
Acute heart failure; NGAL; cardio renal syndrome; outcome; worsening renal function