Admission plasma neutrophil gelatinase associated lipocalin (NGAL) predicts worsening renal function during hospitalization and post discharge outcome in patients with acute heart failure.

Acute cardiac care Pub Date : 2014-09-01 Epub Date: 2014-05-16 DOI:10.3109/17482941.2014.911915
Alberto Palazzuoli, Gaetano Ruocco, Matteo Beltrami, Beatrice Franci, Marco Pellegrini, Barbara Lucani, Ranuccio Nuti, Claudio Ronco
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引用次数: 37

Abstract

Unlabelled: Abstract Background: The role of neutrophil gelatinase-associated lipocalin (NGAL) has been described in chronic heart failure (HF), however less data are available in patients admitted for acute HF.

Methods: We evaluated the role of NGAL in predicting in-hospital worsening renal function (WRF) and post-discharge follow-up during six months period in patients with acute HF. All patients were submitted to creatinine, estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN) and B-type natriuretic peptide (BNP) measurement during hospitalization and before discharge.

Results: Patients with chronic kidney dysfunction (CKD) demonstrated higher NGAL respect to subject with preserved renal function (241 ± 218 and 130 ± 80 ng/ml; P = 0.0001). In subgroup that developed WRF during hospitalization, NGAL levels were significantly increased respect to patients without WRF (272 ± 205 versus 136 ± 127 ng/ml; P = 0.0001). A cut off of 134 ng/ml has been related to WRF with good sensibility and specificity (92% and 71% AUC 0.83; P = 0.001). Multivariable Cox regression analysis showed that cut-off of 134 ng/ml was the only marker related to death (HR: 1.75; 95% CI: 1.24-2.45; P < 0.001). Follow-up analysis confirmed that NGAL > 130 ng/ml was associated with adverse events during a six-month period.

Conclusion: Admission NGAL measurement appears a sensible tool for in-hospital WRF prediction as well as an early marker for adverse outcome during post discharge vulnerable phase.

入院时血浆中性粒细胞明胶酶相关脂钙蛋白(NGAL)预测急性心力衰竭患者住院期间肾功能恶化和出院后预后。
背景:中性粒细胞明胶酶相关脂钙蛋白(NGAL)在慢性心力衰竭(HF)中的作用已被描述,但在急性心力衰竭患者中可获得的数据较少。方法:评价NGAL在预测急性心衰患者住院期间肾功能恶化(WRF)及出院后随访6个月中的作用。所有患者均于住院期间及出院前测定肌酐、肾小球滤过率(eGFR)、血尿素氮(BUN)及b型利钠肽(BNP)。结果:慢性肾功能不全(CKD)患者NGAL水平高于肾功能保存者(241±218和130±80 ng/ml);P = 0.0001)。在住院期间发生WRF的亚组中,相对于没有WRF的患者,NGAL水平显著升高(272±205 vs 136±127 ng/ml);P = 0.0001)。134 ng/ml的截断值与WRF相关,具有良好的敏感性和特异性(92%和71% AUC 0.83;P = 0.001)。多变量Cox回归分析显示,134 ng/ml的临界值是与死亡相关的唯一指标(HR: 1.75;95% ci: 1.24-2.45;P < 0.001)。随访分析证实,NGAL > 130 ng/ml与6个月期间的不良事件相关。结论:入院NGAL测量是院内WRF预测的有效工具,也是出院后脆弱期不良结局的早期标志。
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