Short-term prognostic implications of serum and urine neutrophil gelatinase-associated lipocalin in acute heart failure: findings from the AKINESIS study

Aims Kidney impairment has been associated with worse outcomes in acute heart failure (AHF), although recent studies challenge this association. Neutrophil gelatinase-associated lipocalin (NGAL) is a novel biomarker of kidney tubular injury. Its prognostic role in AHF has not been evaluated in large...

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Detalhes bibliográficos
Autores: Wettersten, N, Horiuchi, Y, van Veldhuisen, DJ, Mueller, C, Filippatos, G, Nowak, R, Hogan, C, Kontos, MC, Cannon, CM, Mueller, GA, Birkhahn, R, Taub, P, Vilke, GM, Barnett, O, McDonald, K, Mahon, N, Nunez, J, Briguori, C, Passino, C, Maisel, A, Murray, PT
Formato: artículo
Estado:Versión publicada
Fecha de publicación:2020
País:España
Recursos:INCLIVA
Repositorio:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
OAI Identifier:oai:incliva.fundanetsuite.com:p4363
Acesso em linha:https://incliva.portalinvestigacion.com/publicaciones/4363
Access Level:acceso abierto
Palavra-chave:Acute heart failure
Kidney function
Biomarkers
Prognosis
Descrição
Resumo:Aims Kidney impairment has been associated with worse outcomes in acute heart failure (AHF), although recent studies challenge this association. Neutrophil gelatinase-associated lipocalin (NGAL) is a novel biomarker of kidney tubular injury. Its prognostic role in AHF has not been evaluated in large cohorts. The present study aimed to determine if serumNGAL (sNGAL) or urineNGAL (uNGAL) is superior to creatinine for predicting short-term outcomes in AHF Methods and results The study was conducted in an international, multicentre, prospective cohort consisting of 927 patients with AHF. Admission and peak values of sNGAL, uNGAL and uNGAL/urine creatinine (uCr) ratio were compared to admission and peak serum creatinine (sCr). The composite endpoints were death, initiation of renal replacement therapy, heart failure (HF) readmission and any emergent HF-related outpatient visit within 30 and 60 days, respectively. The mean age of the cohort was 69 years and 62% were male. The median length of stay was 6 days. The composite endpoint occurred in 106 patients and 154 patients within 30 and 60 days, respectively. Serum NGAL was more predictive than uNGAL and the uNGAL/uCr ratio but was not superior to sCr [area under the curve: admission sNGAL 0.61, 95% confidence interval (CI) 0.55- 0.67, and 0.59, 95% CI 0.54- 0.65; peak sNGAL: 0.60, 95% CI 0.54-0.66, and 0.57, 95% CI 0.52- 0.63; admission sCr: 0.60, 95% CI 0.54- 0.64, and 0.59, 95% CI 0.53- 0.64; peak sCr: 0.61, 95% CI 0.55-0.67, and 0.59, 95% CI 0.54- 0.64, at 30 and 60 days, respectively]. NGAL was not predictive of the composite endpoint in multivariate analysis. Conclusions Serum NGAL outperformed uNGAL but neither was superior to admission or peak sCr for predicting adverse events.

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