Estimating the prevalence of elevated plasma neutrophil gelatinase associated lipocalin level in patients with acute coronary syndromes and its association with outcomes

Lahiri, Anandaroop; Alex, Anoop George; George, Paul V

doi:10.1016/j.ihj.2017.06.005

Cited by 6 publications

(3 citation statements)

References 14 publications

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“…These studies further confirmed the importance of NGAL in clinical applications. Interestingly, in contrast, a study showed that plasma NGAL levels do not predict the severity of CAD [34]. Other studies confirmed that plasma NGAL concentrations do not predict mortality independent of renal function and provide no additional benefit to inflammatory biomarkers and conventional cardiovascular risk factors in predicting cardiovascular events in stable CAD patients [20, 35].…”

Section: Discussionmentioning

confidence: 99%

Plasma neutrophil gelatinase-associated lipocalin levels are associated with the presence and severity of coronary heart disease

Zhang

et al. 2019

PLoS ONE

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Objective This study aimed to compare the levels of plasma neutrophil gelatinase-associated lipocalin (NGAL), matrix metalloproteinase (MMP)-9, high-sensitivity C-reactive protein (hs-CRP), and interleukin (IL)-1β across different clinical presentations of coronary artery disease and to evaluate the relationship between those biomarkers and the severity of coronary artery lesions in patients without kidney disease. Methods We examined 365 eligible patients who underwent coronary angiography. A total of 124 ST-segment elevation myocardial infarction (STEMI) patients, 117 stable angina pectoris (SAP) patients and 124 patients without atherosclerotic plaques were enrolled in the study. Plasma NGAL, MMP-9, hs-CRP, and IL-1β were measured in all patients using the enzyme-linked immunosorbent assay (ELISA) method. According to the SYNTAX score, the STEMI patients and SAP patients were divided into another set of 2 groups: a high score group (≥ 33, n = 29) and a low score group (<33, n = 212). The relationship between those biomarkers and the severity of coronary stenosis was examined by Spearman correlation analysis; the ability for NGAL to discriminate severe coronary stenosis was examined by receiver operating characteristic (ROC) curve; the influencing factors for the SYNTAX score were determined by logistic regression analysis. Results Plasma NGAL, MMP-9, and hs-CRP levels in STEMI patients were higher than in the SAP patients and control subjects (P<0.05, respectively), and plasma NGAL and hs-CRP levels were significantly higher in the SAP patients than in control subjects (P<0.05, respectively), while plasma IL-1β was similar among the 3 groups (P>0.05, respectively). The SYNTAX score was positively related to NGAL (r = 0.363, P<0.001), MMP-9 (r = 0.377, P<0.001), and hs-CRP (r = 0.163, P<0.011); the SYNTAX score was not related to IL-1β (r = -0.043, P = 0.510). Plasma NGAL was positively related to MMP-9 (r = 0.601, P<0.001) and IL-1β (r = 0.159, P = 0.014). The area under the ROC curve for NGAL discriminating severe coronary stenosis was 0.838 (95% CI: 0.752–0.923, P<0.001), which was greater than that for MMP-9 [0.818, (95% CI: 0.724–0.912, P<0.001)], IL-1β [0.485, (95% CI: 0.369–0.601, P = 0.791)], and hs-CRP [0.607, (95% CI: 0.492–0.722, P = 0.061)]. Multivariate regression analysis showed that plasma NGAL levels were independently related to high SYNTAX scores [OR = 1.109, (95% CI: 1.104–1.114), P<0.001]. Conclusion Plasma NGAL, MMP-9, and hs-CRP levels in STEMI patients were higher than those in the SAP patients and control subjects. NGAL had a better ability to discriminate severe coronary stenosis than MMP-9, IL-1β, and hs-CRP. NGAL may be a novel biomarker to aid in risk stratification in coronary heart disease patients.

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Section: Discussionmentioning

confidence: 99%

Plasma neutrophil gelatinase-associated lipocalin levels are associated with the presence and severity of coronary heart disease

Zhang

et al. 2019

PLoS ONE

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“…Moreover, only three patients died in our study; thus, we cannot conclude, nor hypothesize the role of NGAL in this regard. It is important to mention that NGAL has been recently associated with heart failure and coronary artery disease possible as a manifestation of inflammation [41]; and essential aspect that needs to be kept in mind because this condition could develop a false positive scenario. Besides this, some patients that required hemodialysis had higher baseline sCr, which could imply some undiagnosed cases of the chronic kidney, which could have an impact on the initial value of NGAL.…”

Section: Discussionmentioning

confidence: 99%

Serum levels of neutrophil Gelatinase associated Lipocalin (NGAL) predicts hemodialysis after coronary angiography in high risk patients with acute coronary syndrome

et al. 2020

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Background: Contrast-induced nephropathy (CIN) following a percutaneous coronary intervention (PCI) is the third most common cause of acute kidney injury (AKI) worldwide. Patients who require hemodialysis secondary to CIN have an elevated mortality rate as high as 55%. The current definition of CIN is based on an elevation of creatinine and decrease in urinary output. Creatinine typically increases 48 h after the contrast exposure, which delays the diagnosis and treatment of CIN. The neutrophil gelatinase associated lipocalin (NGAL) has emerged as a sensitive and specific biomarker of renal injury. Limited data exists about the effectiveness of NGAL to predict CIN in highrisk patients with acute coronary syndrome (ACS) that underwent PCI. The primary aim of this study was to determine the association of serum NGAL levels and the need for hemodialysis after PCI. Methods: This is a prospective, observational study. NGAL levels were measured using ELISA. Blood samples were obtained within the first 6 h of hospital admission, and 12 and 24 h after contrast exposure from angiography. The primary outcome was the requirement of hemodialysis. The non-parametric Mann-Whitney U test was used to test for differences in median serum levels of NGAL. A receiver operating characteristic (ROC) curve was developed to assess the accuracy of NGAL to predict the need for hemodialysis after PCI. Results: A total of 2875 were screened; however, 45 patients with ACS that underwent PCI were included. All patients were at high risk of developing CIN defined by Mehran score > 11 points. The median (IQR) serum concentration of NGAL was significantly higher in patients that required versus did not require hemodialysis (340 [83-384] vs. 169 [100-210], p = 0.01). Elevated serum levels of NGAL with a cutoff at 6 h post PCI of 281 mg/dL predicted the need for hemodialysis with an area under the curve of 0.86 (95% CI, 0.66-1.00).

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“…This also limits our ability to performance of all statistical tests to assess the performance of NGAL as a diagnostic marker in the early detection of patients with CIN requiring hemodialysis. Besides this, is important to mention that NGAL has been recently associated with heart failure and coronary artery disease possible as a manifestation of inflammation [41]; and important aspect that needs to be keep in mind because this condition could develop a false positive scenario.…”

Section: Discussionmentioning

confidence: 99%

Serum Levels of Neutrophil Gelatinase Associated Lipocalin (NGAL) Predicts Hemodialysis After Coronary Angiography in High Risk Patients with Acute Coronary Syndrome.

Reyes

Bustamante

Severiche-Bueno

et al. 2019

Preprint

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Aim To determine the association of serum the Neutrophil Gelatinase Associated Lipocalin (NGAL) levels and the need for hemodialysis after percutaneous coronary intervention (PCI).Design This is a prospective, observational study.Setting A cardiovascular and University referral hospital.Patients Patients with Acute Coronary Syndrome (ACS) that underwent PCI, during two consecutive years were enrolled in our study.Main variables of interest NGAL levels were measured using ELISA. Blood samples were obtained within the first 6 hours of hospital admission, and 12 and 24 hours after contrast exposure from angiography. The primary outcome was the requirement of hemodialysis. The non-parametric Mann-Whitney U Test was used to test for differences in median serum levels of NGAL. A receiver operating characteristic (ROC) curve was developed to assess the accuracy of NGAL to predict need for hemodialysis after PCI.Results A total of 2,875 were screened; however, 45 patients with ACS that underwent PCI were included. All patients were at high risk of developing Contrast-induced nephropathy (CIN) defined by Mehran score >11 points. The median (IQR) serum concentration of NGAL was significantly higher in patients that required versus did not require hemodialysis (340 [83-384] vs. 169 [100-210], p=0.01). Elevated serum levels of NGAL predicted the need for hemodialysis with an area under the curve of 0.86 (95% CI: 0.66-1.00).Conclusions In patients with ACS undergoing PCI and high risk of developing CIN, an elevated serum level of NGAL 6 hours after contrast exposure predicts development of acute kidney injury requiring hemodialysis.

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Estimating the prevalence of elevated plasma neutrophil gelatinase associated lipocalin level in patients with acute coronary syndromes and its association with outcomes

Abstract: This is a small study that shows that plasma NGAL in patients admitted with ACS can predict hospital mortality and forms the basis for consideration of this molecule as a possible new risk marker in ACS meriting further and more extensive investigation.

Cited by 6 publications

References 14 publications

Plasma neutrophil gelatinase-associated lipocalin levels are associated with the presence and severity of coronary heart disease

Plasma neutrophil gelatinase-associated lipocalin levels are associated with the presence and severity of coronary heart disease

Serum levels of neutrophil Gelatinase associated Lipocalin (NGAL) predicts hemodialysis after coronary angiography in high risk patients with acute coronary syndrome

Serum Levels of Neutrophil Gelatinase Associated Lipocalin (NGAL) Predicts Hemodialysis After Coronary Angiography in High Risk Patients with Acute Coronary Syndrome.

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