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Critical Care
Published in: Critical Care 1/2012

Open Access 01-02-2012 | Research

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

Authors: Tobias Breidthardt, Thenral Socrates, Beatrice Drexler, Markus Noveanu, Corinna Heinisch, Nisha Arenja, Theresia Klima, Christina Züsli, Tobias Reichlin, Mihael Potocki, Raphael Twerenbold, Jürg Steiger, Christian Mueller

Published in: Critical Care | Issue 1/2012

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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 (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.
Appendix
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Literature
1.
Hsu CY, McCulloch CE, Fan D, Ordonez JD, Chertow GM, Go AS: Community-based incidence of acute renal failure. Kidney Int 2007, 72: 208-212. 10.1038/sj.ki.5002297PubMedCentralCrossRefPubMed
2.
Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW: Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 2005, 16: 3365-3370. 10.1681/ASN.2004090740CrossRefPubMed
3.
Ronco C, McCullough P, Anker SD, Anand I, Aspromonte N, Bagshaw SM, Bellomo R, Berl T, Bobek I, Cruz DN, Daliento L, Davenport A, Haapio M, Hillege H, House AA, Katz N, Maisel A, Mankad S, Zanco P, Mebazaa A, Palazzuoli A, Ronco F, Shaw A, Sheinfeld G, Soni S, Vescovo G, Zamperetti N, Ponikowski P, Acute Dialysis Quality Initiative (ADQI) consensus group: Cardio-renal syndromes: report from the consensus conference of the acute dialysis quality initiative. Eur Heart J 2010, 31: 703-711. 10.1093/eurheartj/ehp507PubMedCentralCrossRefPubMed
4.
Hata N, Yokoyama S, Shinada T, Kobayashi N, Shirakabe A, Tomita K, Kitamura M, Kurihara O, Takahashi Y: Acute kidney injury and outcomes in acute decompensated heart failure: evaluation of the RIFLE criteria in an acutely ill heart failure population. Eur J Heart Fail 2010, 12: 32-37. 10.1093/eurjhf/hfp169CrossRefPubMed
5.
Damman K, Navis G, Voors AA, Asselbergs FW, Smilde TD, Cleland JG, van Veldhuisen DJ, Hillege HL: Worsening renal function and prognosis in heart failure: systematic review and meta-analysis. J Card Fail 2007, 13: 599-608. 10.1016/j.cardfail.2007.04.008CrossRefPubMed
6.
Breidthardt T, Socrates T, Noveanu M, Klima T, Heinisch C, Reichlin T, Potocki M, Nowak A, Tschung C, Arenja N, Bingisser R, Mueller C: Effect and Clinical Prediction of Worsening Renal Function in Acute Decompensated Heart Failure. Am J Cardiol 2011, 107: 730-735. 10.1016/j.amjcard.2010.10.056CrossRefPubMed
7.
Bolignano D, Donato V, Coppolino G, Campo S, Buemi A, Lacquaniti A, Buemi M: Neutrophil gelatinase-associated lipocalin (NGAL) as a marker of kidney damage. Am J Kidney Dis 2008, 52: 595-605. 10.1053/j.ajkd.2008.01.020CrossRefPubMed
8.
Wagener G, Jan M, Kim M, Mori K, Barasch JM, Sladen RN, Lee HT: Association between increases in urinary neutrophil gelatinase-associated lipocalin and acute renal dysfunction after adult cardiac surgery. Anesthesiology 2006, 105: 485-491. 10.1097/00000542-200609000-00011CrossRefPubMed
9.
Mishra J, Dent C, Tarabishi R, Mitsnefes MM, Ma Q, Kelly C, Ruff SM, Zahedi K, Shao M, Bean J, Mori K, Barasch J, Devarajan P: Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet 2005, 365: 1231-1238. 10.1016/S0140-6736(05)74811-XCrossRefPubMed
10.
Bachorzewska-Gajewska H, Malyszko J, Sitniewska E, Malyszko JS, Dobrzycki S: Neutrophil-gelatinase-associated lipocalin and renal function after percutaneous coronary interventions. Am J Nephrol 2006, 26: 287-292. 10.1159/000093961CrossRefPubMed
11.
Hirsch R, Dent C, Pfriem H, Allen J, Beekman RH, Ma Q, Dastrala S, Bennett M, Mitsnefes M, Devarajan P: NGAL is an early predictive biomarker of contrast-induced nephropathy in children. Pediatr Nephrol 2007, 22: 2089-2095. 10.1007/s00467-007-0601-4CrossRefPubMed
12.
Nickolas TL, O'Rourke MJ, Yang J, Sise ME, Canetta PA, Barasch N, Buchen C, Khan F, Mori K, Giglio J, Devarajan P, Barasch J: Sensitivity and specificity of a single emergency department measurement of urinary neutrophil gelatinase-associated lipocalin for diagnosing acute kidney injury. Ann Intern Med 2008, 148: 810-819.PubMedCentralCrossRefPubMed
13.
de Geus HR, Bakker J, Lesaffre EM, le Noble JL: Neutrophil gelatinase-associated lipocalin at ICU admission predicts for acute kidney injury in adult patients. Am J Respir Crit Care Med 2011, 183: 907-914. 10.1164/rccm.200908-1214OCCrossRefPubMed
14.
Wheeler DS, Devarajan P, Ma Q, Harmon K, Monaco M, Cvijanovich N, Wong HR: Serum neutrophil gelatinase-associated lipocalin (NGAL) as a marker of acute kidney injury in critically ill children with septic shock. Crit Care Med 2008, 36: 1297-1303. 10.1097/CCM.0b013e318169245aPubMedCentralCrossRefPubMed
15.
Siew ED, Ware LB, Gebretsadik T, Shintani A, Moons KG, Wickersham N, Bossert F, Ikizler TA: Urine neutrophil gelatinase-associated lipocalin moderately predicts acute kidney injury in critically ill adults. J Am Soc Nephrol 2009, 20: 1823-1832. 10.1681/ASN.2008070673PubMedCentralCrossRefPubMed
16.
Dickstein K: ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: application of natriuretic peptides. Reply. Eur Heart J 2008 2009, 30: 383.
17.
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A: Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007, 11: R31. 10.1186/cc5713PubMedCentralCrossRefPubMed
18.
Aghel A, Shrestha K, Mullens W, Borowski A, Tang WH: Serum neutrophil gelatinase-associated lipocalin (NGAL) in predicting worsening renal function in acute decompensated heart failure. J Card Fail 2010, 16: 49-54. 10.1016/j.cardfail.2009.07.003PubMedCentralCrossRefPubMed
19.
Alvelos M, Pimentel R, Pinho E, Gomes A, Lourenco P, Teles MJ, Almeida P, Guimaraes JT, Bettencourt P: Neutrophil gelatinase-associated lipocalin in the diagnosis of type 1 cardio-renal syndrome in the general ward. Clin J Am Soc Nephrol 2011, 6: 476-481. 10.2215/CJN.06140710PubMedCentralCrossRefPubMed
20.
Tang WH, Mullens W: Cardiorenal syndrome in decompensated heart failure. Heart 2010, 96: 255-260. 10.1136/hrt.2009.166256CrossRefPubMed
21.
Ljungman S, Laragh JH, Cody RJ: Role of the kidney in congestive heart failure. Relationship of cardiac index to kidney function. Drugs 1990,39(Suppl 4):10-21. discussion 22-14CrossRefPubMed
22.
Damman K, van Deursen VM, Navis G, Voors AA, van Veldhuisen DJ, Hillege HL: Increased central venous pressure is associated with impaired renal function and mortality in a broad spectrum of patients with cardiovascular disease. J Am Coll Cardiol 2009, 53: 582-588. 10.1016/j.jacc.2008.08.080CrossRefPubMed
23.
Uthoff H, Breidthardt T, Klima T, Aschwanden M, Arenja N, Socrates T, Heinisch C, Noveanu M, Frischknecht B, Baumann U, Jaeger KA, Mueller C: Central venous pressure and impaired renal function in patients with acute heart failure. Eur J Heart Fail 2011, 13: 432-439. 10.1093/eurjhf/hfq195CrossRefPubMed
24.
Endre ZH, Pickering JW, Walker RJ, Devarajan P, Edelstein CL, Bonventre JV, Frampton CM, Bennett MR, Ma Q, Sabbisetti VS, Vaidya VS, Walcher AM, Shaw GM, Henderson SJ, Nejat M, Schollum JB, George PM: Improved performance of urinary biomarkers of acute kidney injury in the critically ill by stratification for injury duration and baseline renal function. Kidney Int 2011, 79: 1119-1130. 10.1038/ki.2010.555CrossRefPubMed
25.
Lameire NH, Vanholder RC, Van Biesen WA: How to use biomarkers efficiently in acute kidney injury. Kidney Int 2011, 79: 1047-1050. 10.1038/ki.2011.21CrossRefPubMed
26.
Damman K, van Veldhuisen DJ, Navis G, Voors AA, Hillege HL: Urinary neutrophil gelatinase associated lipocalin (NGAL), a marker of tubular damage, is increased in patients with chronic heart failure. Eur J Heart Fail 2008, 10: 997-1000. 10.1016/j.ejheart.2008.07.001CrossRefPubMed
27.
Poniatowski B, Malyszko J, Bachorzewska-Gajewska H, Malyszko JS, Dobrzycki S: Serum neutrophil gelatinase-associated lipocalin as a marker of renal function in patients with chronic heart failure and coronary artery disease. Kidney Blood Press Res 2009, 32: 77-80. 10.1159/000208989CrossRefPubMed
28.
Maisel AS, Mueller C, Fitzgerald R, Brikhan R, Hiestand BC, Iqbal N, Clopton P, van Veldhuisen DJ: Prognostic utility of plasma neutrophil gelatinase-associated lipocalin in patients with acute heart failure: the NGAL EvaLuation Along with B-type NaTriuretic Peptide in acutely decompensated heart failure (GALLANT) trial. Eur J Heart Fail 2011, 13: 846-851. 10.1093/eurjhf/hfr087PubMedCentralCrossRefPubMed
29.
Alvelos M, Lourenco P, Dias C, Amorim M, Rema J, Leite AB, Guimaraes JT, Almeida P, Bettencourt P: Prognostic value of neutrophil gelatinase-associated lipocalin in acute heart failure. Int J Cardiol, in press.
30.
Devarajan P: Review: neutrophil gelatinase-associated lipocalin: a troponin-like biomarker for human acute kidney injury. Nephrology (Carlton) 2010, 15: 419-428. 10.1111/j.1440-1797.2010.01317.xCrossRef
31.
Bolignano D, Coppolino G, Donato V, Lacquaniti A, Bono C, Buemi M: Neutrophil gelatinase-associated lipocalin (NGAL): a new piece of the anemia puzzle? Med Sci Monit 2010, 16: RA131-135.PubMed
32.
Yan QW, Yang Q, Mody N, Graham TE, Hsu CH, Xu Z, Houstis NE, Kahn BB, Rosen ED: The adipokine lipocalin 2 is regulated by obesity and promotes insulin resistance. Diabetes 2007, 56: 2533-2540. 10.2337/db07-0007CrossRefPubMed
33.
Yndestad A, Landrø L, Ueland T, Dahl CP, Flo TH, Vinge LE, Espevik T, Frøland SS, Husberg C, Christensen G, Dickstein K, Kjekshus J, Øie E, Gullestad L, Aukrust P: Increased systemic and myocardial expression of neutrophil gelatinase-associated lipocalin in clinical and experimental heart failure. Eur Heart J 2009, 30: 1229-1236. 10.1093/eurheartj/ehp088CrossRefPubMed
34.
Haase M, Bellomo R, Devarajan P, Schlattmann P, Haase-Fielitz A: Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis 2009, 54: 1012-1024. 10.1053/j.ajkd.2009.07.020CrossRefPubMed
35.
Coca SG, Peixoto AJ, Garg AX, Krumholz HM, Parikh CR: The prognostic importance of a small acute decrement in kidney function in hospitalized patients: a systematic review and meta-analysis. Am J Kidney Dis 2007, 50: 712-720. 10.1053/j.ajkd.2007.07.018CrossRefPubMed
36.
Gottlieb SS, Abraham W, Butler J, Forman DE, Loh E, Massie BM, O'Connor CM, Rich MW, Stevenson LW, Young J, Krumholz HM: The prognostic importance of different definitions of worsening renal function in congestive heart failure. J Card Fail 2002, 8: 136-141. 10.1054/jcaf.2002.125289CrossRefPubMed
37.
Worster A, Carpenter C: Incorporation bias in studies of diagnostic tests: how to avoid being biased about bias. CJEM 2008, 10: 174-175.PubMed
38.
Whiting P, Rutjes AW, Reitsma JB, Glas AS, Bossuyt PM, Kleijnen J: Sources of variation and bias in studies of diagnostic accuracy: a systematic review. Ann Intern Med 2004, 140: 189-202.CrossRefPubMed
39.
Forman DE, Butler J, Wang Y, Abraham WT, O'Connor CM, Gottlieb SS, Loh E, Massie BM, Rich MW, Stevenson LW, Young JB, Krumholz HM: Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure. J Am Coll Cardiol 2004, 43: 61-67. 10.1016/j.jacc.2003.07.031CrossRefPubMed
40.
Cowie MR, Komajda M, Murray-Thomas T, Underwood J, Ticho B: Prevalence and impact of worsening renal function in patients hospitalized with decompensated heart failure: results of the prospective outcomes study in heart failure (POSH). Eur Heart J 2006, 27: 1216-1222.CrossRefPubMed
Metadata
Title
Plasma neutrophil gelatinase-associated lipocalin for the prediction of acute kidney injury in acute heart failure
Authors
Tobias Breidthardt
Thenral Socrates
Beatrice Drexler
Markus Noveanu
Corinna Heinisch
Nisha Arenja
Theresia Klima
Christina Züsli
Tobias Reichlin
Mihael Potocki
Raphael Twerenbold
Jürg Steiger
Christian Mueller
Publication date
01-02-2012
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2012
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc10600

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