Elevated Neutrophil Gelatinase-Associated Lipocalin for the Assessment of Structural versus Functional Renal Damage among ST-Segment Elevation Myocardial Infarction Patients

Abstract

Background: Neutrophil gelatinase-associated lipocalin (NGAL) is an early marker of renal tubular damage. We investigated the incidence and possible implications of elevated NGAL levels (suggesting renal damage) compared to both functional and damage markers (manifested as serum creatinine [sCr] elevation) and no NGAL/sCr change, among ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI). Methods: We included 131 patients with STEMI treated with PCI. Blood samples for plasma NGAL were drawn 24 h following PCI. We used the terms NGAL(-) or NGAL(+) with levels ≥100 ng/mL suggesting renal tubular damage and the terms. sCr(-) or sCr(+) to consensus diagnostic increases in sCr defining acute kidney injury. Patients were also assessed for in hospital-adverse outcomes. Results: Of the study patients, 56 (42%) were NGAL(-)/sCr(-), 58 (44%) NGAL(+)/sCr(-), and 18 (14%) were both NGAL(+)/sCr(+). According to the 3 study groups, there was a stepwise increase in the proportion of left ventricular ejection fraction ≤45% (43 vs. 60. vs. 72%; p = 0.04), in-hospital adverse outcomes (9 vs. 14 vs. 56%; p < 0.001) and their combination. Specifically, more NGAL(+)/ sCr(-) patients developed the composite endpoint when compared to NGAL(-)/sCr(-) patients (64 vs. 46%; OR 2.1, [95% CI 1.1-4.5], p = 0.05). A similar and consistent increase was observed in peak sCr, length of hospital stay, and C-reactive protein levels. Conclusions: Elevated NGAL levels suggesting renal tubular damage, increased inflammation, or both are common among STEMI patients and are associated with adverse outcomes even in the absence of diagnostic increase in sCr.

Neutrophil Gelatinase-Associated Lipocalin Contributes to Increased Risk of Cardiovascular Death After Acute Coronary Syndrome

“… 29 Moreover, one study reported that among patients with ACS, elevated NGAL levels were associated with adverse outcomes. 30 These previous findings are consistent with our results, that elevated serum NGAL levels and NGAL expression in tissues are associated with adverse CV events. However, differently from the previous studies, our results were based on corrected renal function so that abnormal renal function did not affect the independent association between serum NGAL and CV events in patients with CHD.…”

Time Is Kidney: Relation between Pain-to-Balloon Time and Acute Kidney Injury among ST Segment Elevation Patients Undergoing Primary Percutaneous Intervention

“…More profound and prolonged hypoperfusion primarily affects both function and structure of renal tubular epithelial cells, which, in severe cases, is characterized by epithelial-cell ischemia and necrosis. Indeed, in the present study, patients having longer PTB demonstrated graded increase in NGAL levels, an early marker of renal tubular structural damage even in the absence of functional AKI [21]. Nevertheless, ischemia-related injury may not only exclusively result in alterations of epithelial-cell function and structure but also causes interstitial inflammation and microvasculopathy, increasing susceptibility to contrast-induced AKI [9-11].…”

NGAL as Biomarker of Clinical and Subclinical Damage of Kidney Function after Coronary Angiography

“…On the other hand other studies [40,50] suggest a limit as an increase > 25% of the biomarker, or assume that for the diagnosis of subclinical AKI, the biomarker must increase 2 times compared to its baseline levels [41,51]. In the studies of Breglia et al [52] and Rozenfield et al [53], an absolute value is introduced as a reference limit above which the biomarker is reported as positive. While some authors reported an incidence of subclinical AKI of 11.1% [41], others reported a "biomarker (+)/creatinine (−)" cohort with an incidence of 32.6% [50] to 44% [53].…”