title: Plasma neutrophil gelatinase-associated lipocalin predicts major adverse cardiovascular events after cardiac care unit discharge.
abstract: BACKGROUND
  Emerging acute kidney injury biomarkers, including neutrophil gelatinase-associated lipocalin (NGAL), have a high potential for predicting worsening renal function. Acute exacerbation of renal dysfunction has a great impact on the outcomes of cardiovascular patients in critical conditions. This study aimed to evaluate whether plasma NGAL can predict the mortality and major adverse cardiovascular events (MACEs) after discharge from the cardiac care unit (CCU).
  
  
  METHODS
  Patients who were admitted to the CCU of the Tokyo University Hospital were prospectively enrolled (101 patients). Blood and urinary markers, including the blood NGAL, brain natriuretic peptide, creatinine, cystatin C, urinary albumin, N-acetyl-β-d-glucosaminidase, and L-type fatty acid-binding protein, were measured at CCU discharge. The primary outcome was MACEs until at least 6 months after CCU discharge.
  
  
  RESULTS
  Thirty-five patients experienced MACEs (35%). Multivariate logistic analysis revealed that the plasma NGAL, length of CCU stay, and existence of diabetes and heart failure were independent predicting factors for MACEs. Patients with the highest NGAL at discharge (>75th percentile) showed a significantly higher risk of MACEs than those with the lowest NGAL (<25th percentile) (log-rank test; hazard ratio, 5.15; 95% confidence interval 1.84-18.20; p<0.01).
  
  
  CONCLUSIONS
  Plasma NGAL at CCU discharge is a significant prognostic indicator of outcomes at 6 months in critically ill cardiac patients treated in a CCU.
authors.affiliation: Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Masamichi
authors.initials: M
authors.lastname: Ito
authors.affiliation: Department of Emergency and Critical Care Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Kent
authors.initials: K
authors.lastname: Doi
authors.affiliation: Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan. Electronic address: masaotakahashi-gi@umin.org.
authors.forename: Masao
authors.initials: M
authors.lastname: Takahashi
authors.affiliation: Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Koyama
authors.affiliation: Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Myojo
authors.affiliation: Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Hosoya
authors.affiliation: Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Arihiro
authors.initials: A
authors.lastname: Kiyosue
authors.affiliation: Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Ando
authors.affiliation: Department of Hemodialysis and Apheresis, The University of Tokyo, Tokyo, Japan.
authors.forename: Eisei
authors.initials: E
authors.lastname: Noiri
authors.affiliation: Department of Emergency and Critical Care Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Yahagi
authors.affiliation: Tokyo Teishin Hospital, Tokyo, Japan.
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Hirata
authors.affiliation: Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Issei
authors.initials: I
authors.lastname: Komuro
mesh_terms: D000118:Acetylglucosaminidase / Q000652:urine; D058186:Acute Kidney Injury / Q000097:blood* / Q000150:complications / Q000652:urine; D000209:Acute-Phase Proteins; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000150:complications; D015415:Biomarkers / Q000097:blood / Q000652:urine; D002318:Cardiovascular Diseases / Q000209:etiology*; D003325:Coronary Care Units / Q000706:statistics & numerical data*; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood; D050556:Fatty Acid-Binding Proteins / Q000652:urine; D005260:Female; D006333:Heart Failure / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000097:blood*; D014041:Tokyo
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D055316:Cystatin C; D050556:Fatty Acid-Binding Proteins; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D020097:Natriuretic Peptide, Brain; D003404:Creatinine; D000118:Acetylglucosaminidase
keywords: Adverse cardiac events; Brain natriuretic peptide; Cardiac care unit; Neutrophil gelatinase-associated lipocalin