Plasma neutrophil gelatinase-associated lipocalin for the prediction of acute kidney injury in acute heart failure.
Crit Care. 2012 Jan 7;16(1):R2
Authors: Breidthardt T, Socrates T, Drexler B, Noveanu M, Heinisch C, Arenja N, Klima T, Zusli C, Reichlin T, Potocki M, Twerenbold R, Steiger J, Mueller C
ABSTRACT: 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 [IQR, 91-203] umol/l vs. 97 [76-132] umol/l, p<0.01) and NGAL (114.5 [67.1-201.5] ng/ml vs. 74.5 [60-113.9] 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 0.59-0.79 vs. NGAL 0.67; 95%CI 0.57-0.77). Serial measurements of NGAL did not further increase the prognostic accuracy for AKI. Creatinine, but not NGAL, remained an independent predictor of AKI (HR 1.15; 95%CI 1.01-1.31; p=0.04) in multivariable regression analysis. CONCLUSION: Plasma NGAL levels do not adequately predict AKI in patients with AHF.
PMID: 22226205 [PubMed - as supplied by publisher]