Plasma neutrophil gelatinase-associated lipocalin for the prediction of acute kidney injury in acute heart failure

TY - JOUR

T1 - Plasma neutrophil gelatinase-associated lipocalin for the prediction of acute kidney injury in acute heart failure

AU - Breidthardt, Tobias

AU - Socrates, Thenral

AU - Drexler, Beatrice

AU - Noveanu, Markus

AU - Heinisch, Corinna

AU - Arenja, Nisha

AU - Klima, Theresia

AU - Züsli, Christina

AU - Reichlin, Tobias

AU - Potocki, Mihael

AU - Twerenbold, Raphael

AU - Steiger, Jürg

AU - Mueller, Christian

N1 - Funding Information: We are indebted to the patients who participated in the study and to the Emergency Department staff as well as the laboratory technicians for their most valuable efforts. Furthermore, the authors thank Dr. Etienne Gayat, Hôpital Lariboisière APHP; University Paris for his statistical support. This study was supported by research grants from the University of Basel (to Dr. Breidthardt), the Swiss National Science Foundation (to Dr. Mueller), and ALERE. The funding bodies had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

PY - 2012/1/7

Y1 - 2012/1/7

N2 - Introduction: The accurate prediction of acute kidney injury (AKI) in patients with acute heart failure (AHF) is an unmet clinical need. Neutrophil gelatinase-associated lipocalin (NGAL) is a novel sensitive and specific marker of AKI.Methods: A total of 207 consecutive patients presenting to the emergency department with AHF were enrolled. Plasma NGAL was measured in a blinded fashion at presentation and serially thereafter. The potential of plasma NGAL levels to predict AKI was assessed as the primary endpoint. We defined AKI according to the AKI Network classification.Results: Overall 60 patients (29%) experienced AKI. These patients were more likely to suffer from pre-existing chronic cardiac or kidney disease. At presentation, creatinine (median 140 (interquartile range (IQR), 91 to 203) umol/L versus 97 (76 to 132) umol/L, P < 0.01) and NGAL (114.5 (IQR, 67.1 to 201.5) ng/ml versus 74.5 (60 to 113.9) ng/ml, P < 0.01) levels were significantly higher in AKI compared to non-AKI patients. The prognostic accuracy for measurements obtained at presentation, as quantified by the area under the receiver operating characteristic curve was mediocre and comparable for the two markers (creatinine 0.69; 95%CI 0.59 to 0.79 versus NGAL 0.67; 95%CI 0.57 to 0.77). Serial measurements of NGAL did not further increase the prognostic accuracy for AKI. Creatinine, but not NGAL, remained an independent predictor of AKI (hazard ratio (HR) 1.12; 95%CI 1.00 to 1.25; P = 0.04) in multivariable regression analysis.Conclusions: Plasma NGAL levels do not adequately predict AKI in patients with AHF.

AB - Introduction: The accurate prediction of acute kidney injury (AKI) in patients with acute heart failure (AHF) is an unmet clinical need. Neutrophil gelatinase-associated lipocalin (NGAL) is a novel sensitive and specific marker of AKI.Methods: A total of 207 consecutive patients presenting to the emergency department with AHF were enrolled. Plasma NGAL was measured in a blinded fashion at presentation and serially thereafter. The potential of plasma NGAL levels to predict AKI was assessed as the primary endpoint. We defined AKI according to the AKI Network classification.Results: Overall 60 patients (29%) experienced AKI. These patients were more likely to suffer from pre-existing chronic cardiac or kidney disease. At presentation, creatinine (median 140 (interquartile range (IQR), 91 to 203) umol/L versus 97 (76 to 132) umol/L, P < 0.01) and NGAL (114.5 (IQR, 67.1 to 201.5) ng/ml versus 74.5 (60 to 113.9) ng/ml, P < 0.01) levels were significantly higher in AKI compared to non-AKI patients. The prognostic accuracy for measurements obtained at presentation, as quantified by the area under the receiver operating characteristic curve was mediocre and comparable for the two markers (creatinine 0.69; 95%CI 0.59 to 0.79 versus NGAL 0.67; 95%CI 0.57 to 0.77). Serial measurements of NGAL did not further increase the prognostic accuracy for AKI. Creatinine, but not NGAL, remained an independent predictor of AKI (hazard ratio (HR) 1.12; 95%CI 1.00 to 1.25; P = 0.04) in multivariable regression analysis.Conclusions: Plasma NGAL levels do not adequately predict AKI in patients with AHF.

UR - http://www.scopus.com/inward/record.url?scp=84855417554&partnerID=8YFLogxK

U2 - 10.1186/cc10600

DO - 10.1186/cc10600

M3 - SCORING: Journal article

C2 - 22226205

AN - SCOPUS:84855417554

VL - 16

JO - CRIT CARE

JF - CRIT CARE

SN - 1364-8535

IS - 1

M1 - R2

ER -