Serum Neutrophil Gelatinase-Associated Lipocalin (NGAL) in Predicting Worsening Renal Function in Acute Decompensated Heart Failure

Abstract

Background The development of worsening renal function (WRF, defined as creatinine rise ≥0.3 mg/dL) occurs frequently in the setting of acute decompensated heart failure (ADHF) and strongly predicts adverse clinical outcomes. Neutrophil gelatinase–associated lipocalin (NGAL) is produced by the nephron in response to tubular epithelial damage and serves as an early marker for acute renal tubular injury. We sought to determine the relationship between admission serum NGAL levels and WRF in the setting of ADHF. Methods and Results We measured serum NGAL levels in 91 patients admitted to the hospital with ADHF. Patients were adjudicated by independent physician into those that did or did not develop WRF over the ensuing 5 days of in-hospital treatment. In our study cohort (68% male, mean age 61 ± 15 years, mean left ventricular ejection fraction 31 ± 14%), median admission serum NGAL level was 165 ng/mL (interquartile range [IQR] 108–235 ng/mL). Thirty-five patients (38%) developed WRF within the 5-day follow-up. Patients who developed WRF versus those without WRF had significantly higher median admission serum NGAL levels (194 [IQR 150–292] ng/mL vs. 128 [IQR 97–214] ng/mL, P = .001). High serum NGAL levels at admission were associated with greater likelihood of developing WRF (odds ratio: 1.92, 95% confidence interval 1.23–3.12, P = .004). In particular, admission NGAL ≥140 ng/mL had a 7.4-fold increase in risk of developing WRF, with a sensitivity and specificity of 86% and 54%, respectively. Conclusions The presence of elevated admission serum NGAL levels is associated with heightened risk of subsequent development of WRF in patients admitted with ADHF.

SERUM NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN (NGAL) AS A PREDICTIVE BIOMARKER OF KIDNEY INJURY IN RENAL TRANSPLANTED PATIENTS and CHRONIC KIDNEY DISEASE

“…In the present study the higher NGAL level, and the correlations between NGAL and other kidney parameters were studied (results and fig. 1-6) and are in agreement with many reports, which implies that NGAL is an early indicator biomarker for both RT and advanced CKD patients and can be used to start early treatment in these patients [39][40][41][42]. Malyszko et al in their study showed that in patients with delayed graft function; there was no fall in serum NGAL or cystatin-c.…”

Neutrophil Gelatinase-Associated Lipocalin in the Diagnosis of Type 1 Cardio-Renal Syndrome in the General Ward

“…No patient with Ͻ170-ng/ml first-morning NGAL developed type 1 cardio-renal syndrome, and half of the patients with a first-morning value Ͼ170 ng/ml develop type 1 cardiorenal syndrome. The association of higher serum NGAL levels with worsening renal function was already demonstrated by Aghel et al in a population of 91 acute HF patients (17). Different from the latter study in which worsening renal function was considered from the 5th day onward, we restricted type 1 cardio-renal syndrome to the first 48 to 72 hours of admission.…”

Urine neutrophil gelatinase-associated lipocalin levels predict acute kidney injury in acute decompensated heart failure patients

“…19,20 Though, a few studies question the role of NGAL in predicting the risk of AKI, serum NGAL was used as a marker for AKI, and it was also shown to be associated with a higher risk of AKI at different cut-off levels. 21,22 Acute decompensated HF patients with serum NGAL levels over 167.5 ng/mL had 2.7 times increased mortality and 2.9 times increased hospitalization rates. 23 Alvelos et al defined a cut-off value of 170 ng/mL for serum NGAL to foresee type 1 CRS with 100% sensitivity and 86.7% specificity (AUC was 0.93).…”