Prognostic Value of Plasma NGAL for Mortality in Heart Failure Patients.
Circ Heart Fail. 2013 Dec 17;
Authors: van Deursen VM, Damman K, Voors AA, van der Wal MH, Jaarsma T, van Veldhuisen DJ, Hillege HL
Abstract
BACKGROUND: -In patients with heart failure (HF), renal dysfunction is associated with a poor outcome. We aimed to assess the prognostic value of plasma Neutrophil Gelatinase Associated Lipocalin (NGAL), a novel marker of renal tubular damage, in HF patients with or without renal dysfunction, and compare it with two frequently used biomarkers of chronic kidney disease.
METHODS AND RESULTS: -Plasma NGAL, estimated GFR (eGFR) and cystatin C were assessed in 562 heart failure patients. Chronic kidney disease was defined as eGFR<60 mL/min/1.73m(2). Outcome was all-cause mortality at 36 months. Mean age was 71±11, 61% were men and 97% were in New York Heart Association functional class II/III. Mean baseline eGFR was 54±20 mL/min/1.73m(2), mean cystatin C was 11.2 (7.7-16.2) mg/L and median plasma NGAL was 85 (60-123) ng/mL. Higher plasma NGAL levels were independently associated with an increased risk of all cause mortality, in patients with and without chronic kidney disease (HR (per SD increase in log NGAL)=1.45 [1.22-1.72], P<0.001 & HR=1.51 [1.06-2.16], P=0.023 respectively). Similarly, both in patients with high and low cystatin C (median cut-off), higher plasma NGAL levels were independently associated with an increased risk of all cause mortality. Moreover, when NGAL was entered in the multivariable risk prediction model, eGFR (P=0.616) and cystatin C (P=0.937) were no longer associated with mortality.
CONCLUSIONS: -Plasma NGAL predicts mortality in heart failure patients, both in patients with and without chronic kidney disease, and is a stronger predictor for mortality than the established renal function indices eGFR and cystatin C.
PMID: 24347663 [PubMed - as supplied by publisher]