title: Comparison between admission natriuretic peptides, NGAL and sST2 testing for the prediction of worsening renal function in patients with acutely decompensated heart failure.
abstract: BACKGROUND
  In order to predict the occurrence of worsening renal function (WRF) and of WRF plus in-hospital death, 101 emergency department (ED) patients with acute decompensated heart failure (ADHF) were evaluated with testing for amino-terminal pro-B-type natriuretic peptide (NT-proBNP), BNP, sST2, and neutrophil gelatinase associated lipocalin (NGAL).
  
  
  METHODS
  In a prospective international study, biomarkers were collected at the time of admission; the occurrence of subsequent in hospital WRF was evaluated.
  
  
  RESULTS
  In total 26% of patients developed WRF. Compared to patients without WRF, those with WRF had a longer in-hospital length of stay (LOS) (mean LOS 13.1±13.4 days vs. 4.8±3.7 days, p<0.001) and higher in-hospital mortality [6/26 (23%) vs. 2/75 (2.6%), p<0.001]. Among the biomarkers assessed, baseline NT-proBNP (4846 vs. 3024 pg/mL; p=0.04), BNP (609 vs. 435 pg/mL; p=0.05) and NGAL (234 vs. 174 pg/mL; p=0.05) were each higher in those who developed WRF. In logistic regression, the combination of elevated natriuretic peptide and NGAL were additively predictive for WRF (ORNT-proBNP+NGAL=2.79; ORBNP+NGAL=3.11; both p<0.04). Rates of WRF were considerably higher in patients with elevation of both classes of biomarker. Comparable results were observed in a separate cohort of 162 patients with ADHF from a different center.
  
  
  CONCLUSIONS
  In ED patients with ADHF, the combination of NT-proBNP or BNP plus NGAL at presentation may be useful to predict impending WRF (Clinicaltrials.gov NCT#0150153).
authors.forename: Benedetta
authors.initials: B
authors.lastname: De Berardinis
authors.forename: Hanna K
authors.initials: HK
authors.lastname: Gaggin
authors.forename: Laura
authors.initials: L
authors.lastname: Magrini
authors.forename: Arianna
authors.initials: A
authors.lastname: Belcher
authors.forename: Benedetta
authors.initials: B
authors.lastname: Zancla
authors.forename: Alexandra
authors.initials: A
authors.lastname: Femia
authors.forename: Mandy
authors.initials: M
authors.lastname: Simon
authors.forename: Shweta
authors.initials: S
authors.lastname: Motiwala
authors.forename: Anju
authors.initials: A
authors.lastname: Bhardwaj
authors.forename: Blair A
authors.initials: BA
authors.lastname: Parry
authors.forename: John T
authors.initials: JT
authors.lastname: Nagurney
authors.forename: Charles
authors.initials: C
authors.lastname: Coudriou
authors.forename: Matthieu
authors.initials: M
authors.lastname: Legrand
authors.forename: Malha
authors.initials: M
authors.lastname: Sadoune
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Somma
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
mesh_terms: D000208:Acute Disease; D000209:Acute-Phase Proteins; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D001774:Blood Chemical Analysis; D018450:Disease Progression; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D000072179:Interleukin-1 Receptor-Like 1 Protein; D007668:Kidney / Q000503:physiopathology*; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood*; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010343:Patient Admission; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D011518:Proto-Oncogene Proteins / Q000097:blood*; D012372:ROC Curve; D011956:Receptors, Cell Surface / Q000097:blood* / Q000737:chemistry; D012995:Solubility
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C079241:IL1RL1 protein, human; D000072179:Interleukin-1 Receptor-Like 1 Protein; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D010446:Peptide Fragments; D011518:Proto-Oncogene Proteins; D011956:Receptors, Cell Surface; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain