Neutrophil Gelatinase-Associated Lipocalin (NGAL) in Patients with ST-Elevation Myocardial Infarction and Its Association with Acute Kidney Injury and Mortality

Abstract

Neutrophil gelatinase-associated lipocalin (NGAL) is an inflammatory biomarker related to acute kidney injury (AKI). Including 1892 consecutive patients with ST-elevation myocardial infarction (STEMI), in which NGAL was measured in 1624 (86%) on admission and in a consecutive subgroup at 6–12 h (n = 163) and 12–24 h (n = 222) after admission, this study aimed to evaluate the prognostic value of NGAL in predicting AKI and mortality. Patients were stratified based on whether their admission NGAL plasma concentration was greater than or equal to/less than the median. The primary endpoint was a composite of the first occurrence of AKI or all-cause death within 30 days. AKI was classified by the maximal plasma creatinine increase from baseline during index admission as KDIGO1 (<200% increase) or KDIGO23 (≥200% increase) according to the Kidney Disease Improving Global Outcomes (KDIGO) system. Admission NGAL > the median was independently associated with a higher risk of severe AKI (KDIGO2-3) and 30-day all-cause mortality when adjusted for age, admission systolic blood pressure and high-sensitivity C-reactive protein, left-ventricular ejection fraction, known kidney dysfunction, and cardiogenic shock with an odds ratio (95% confidence interval) of 2.26 (1.18–4.51), p = 0.014. Finally, we observed increasing predictive values in a subgroup during the first day of hospitalization suggesting that assessment of NGAL should be delayed for optimal prognostic purposes.

Mortality prognosis of NGAL, NTproBNP, hsTnT, and GRACE score in patients with acute coronary syndrome

“…Ahmet Avci (2020) [17] the study also found a similar result, with beta = 0.017 (p = 0.01) and dependent variables including age, hypertension, T2DM, dyslipidemia, smoking, sex, heart failure, and troponin. NGAL concentration could be biased due to the progression of chronic kidney disease (CKD) or Acute Kidney Injury as shown in the study by Højagergaard MA et al (2023) [24] . However, our study had strictly excluded the patients with kidney conditions, thus the outcome of our study had value meaning for clinical practice.…”

Novel Biomarkers for the Assessment of the Cardio-Renal Syndrome—A Paradigm Shift

“…Their results also demonstrated that NGAL was independently associated with cardiovascular outcomes and performed better than traditional inflammatory markers (e.g., C-reactive protein, leukocyte count, etc.). A second report by Højagergaard and colleagues included a cohort of >1600 patients with myocardial infarction [7]. They demonstrated that an NGAL plasma level above the median was an independent marker for severe AKI and all cause death within 30 days.…”