title: Associations Between Neutrophil Gelatinase Associated Lipocalin, Neutrophil-to-Lymphocyte Ratio, Atrial Fibrillation and Renal Dysfunction in Chronic Heart Failure.
abstract: BACKGROUND Atrial fibrillation (AF) and renal dysfunction are two common comorbidities in patients with chronic heart failure with reduced ejection fraction (HFrEF). This study evaluated the effect of permanent AF on renal function in HFrEF and investigated the associations of atrial fibrillation, neutrophil gelatinase-associated lipocalin (NGAL), and neutrophil-to-lymphocyte ratio (NLR) with adverse clinical outcome. MATERIAL AND METHODS Serum NGAL levels measured by ELISA and NLR were compared between patients with sinus rhythm (HFrEF-SR, n=68), with permanent AF (HFrEF-AF, n=62), and a healthy control group (n=50). RESULTS Mean eGFR levels were significantly lower, and NLR and NGAL levels were significantly higher in the HFrEF patients than in the control patients but the difference between HFrEF-SR and HFrEF-AF was not statistically significant (NGAL: 95 ng/mL in HFrEF-SR, 113 ng/mL in HFrEF-AF and 84 ng/mL in the control group; p<0.001). Independent associates of baseline eGFR were age, hemoglobin, NLR, triiodothyronine, and pulmonary artery systolic pressure. In a mean 16 months follow-up, adverse clinical outcome defined as progression of kidney dysfunction and composite of all-cause mortality and re-hospitalization were not different between HFrEF-SR and HFrEF-AF patients. Although NGAL was associated with clinical endpoints in the univariate analysis, Cox regression analysis showed that independent predictors of increased events were the presence of signs right heart failure, C-reactive protein, NLR, triiodothyronine, and hemoglobin. In ROC analysis, a NLR >3 had a 68% sensitivity and 75% specificity to predict progression of kidney disease (AUC=0.72, 95% CI 0.58-0.85, p=0.001). CONCLUSIONS Presence of AF in patients with HFrEF was not an independent contributor of adverse clinical outcome (i.e., all-cause death, re-hospitalization) or progression of renal dysfunction. Renal dysfunction in HFrEF was associated with both NLR and NGAL levels, but systemic inflammation reflected by NLR seemed to be a more important determinant of progression of kidney dysfunction.
authors.affiliation: Department of Cardiology, Kocaeli State Hospital, Kocaeli, Turkey.
authors.forename: Onur
authors.initials: O
authors.lastname: Argan
authors.affiliation: Department of Cardiology, Koc University, School of Medicine, Istanbul, Turkey.
authors.forename: Dilek
authors.initials: D
authors.lastname: Ural
authors.affiliation: Department of Cardiology, Kocaeli University, Medical Faculty, Kocaeli, Turkey.
authors.forename: Guliz
authors.initials: G
authors.lastname: Kozdag
authors.affiliation: Department of Cardiology, Kocaeli University, Medical Faculty, Kocaeli, Turkey.
authors.forename: Tayfun
authors.initials: T
authors.lastname: Sahin
authors.affiliation: Department of Cardiology, Derince Training and Research Hospital, Kocaeli, Turkey.
authors.forename: Serdar
authors.initials: S
authors.lastname: Bozyel
authors.affiliation: Department of Cardiology, Kocaeli University, Medical Faculty, Kocaeli, Turkey.
authors.forename: Mujdat
authors.initials: M
authors.lastname: Aktas
authors.affiliation: Department of Cardiology, Derince Training and Research Hospital, Kocaeli, Turkey.
authors.forename: Kurtulus
authors.initials: K
authors.lastname: Karauzum
authors.affiliation: Department of Cardiology, Isparta Yalvac State Hospital, Isparta, Turkey.
authors.forename: Irem
authors.initials: I
authors.lastname: Yilmaz
authors.affiliation: Department of Cardiology, Kocaeli University, Medical Faculty, Kocaeli, Turkey.
authors.forename: Emir
authors.initials: E
authors.lastname: Dervis
authors.affiliation: Department of Cardiology, Kocaeli University, Medical Faculty, Kocaeli, Turkey.
authors.forename: Aysen
authors.initials: A
authors.lastname: Agir
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood* / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D000071068:Lipocalin-2 / Q000097:blood*; D008214:Lymphocytes / Q000276:immunology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology*; D011379:Prognosis; D011518:Proto-Oncogene Proteins / Q000097:blood; D051437:Renal Insufficiency / Q000097:blood / Q000503:physiopathology; D013318:Stroke Volume / Q000502:physiology
chemical_list: D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D011518:Proto-Oncogene Proteins