Abstract 12359: Prognostic Utility of Plasma NGAL in Patients Admitted With Heart Failure-30 Day Results of the GALLANT Trial
Introduction: Neutrophil gelatinase associated lipocalin (NGAL) is a measure of acute and on-going kidney injury. Since many patients admitted with acute heart failure (AHF) have renal dysfunction often made worse by diuretics, a marker of renal injury might be important for risk stratification of these patients.
Hypothesis: The Gallant Trial (NGAL evaLuation Along with B-type NaTriuretic Peptide in acutely Decompensated Heart Failure) was a multi-center prospective study to assess the utility of plasma NGAL, alone and in combination with BNP as an aid in early risk assessment of heart-failure related adverse outcomes.
Methods: In 186 adults from 5 centers presenting with AHF , discharge values of serum NGAL and BNP (Inverness, San Diego, CA) were related to 30 and 90 day HF complications (readmission, ED visit) and mortality. The 30 day results are reported here.
Results: Population was 58% male (mean 73 years old). There were 29 events (HF readmissions and all-cause mortality) at 30 days (16%). Those with events had higher levels of NGAL than those without events (134 ng/ml vs 84 ng/ml, p <0.001). The area under the ROC curve was higher for plasma NGAL (.72) than either BNP (.65) or serum creatinine (.57). In multivariate analysis serum creatinine was not significant but both BNP (p=.048) and NGAL (p=.001) were. Using cut-points at the level of 80% specificity for BNP (1027pg/ml) and NGAL (134ng/ml), subjects were sorted by high/low BNP and high/low NGAL. As can be seen, while high BNP/highNGAL had the worst outcomes, high BNP/low NGAL had outcomes similar to when both were low
Conclusions: Plasma NGAL is a measure of kidney injury which at the time of discharge is a strong prognostic indicator of 30 day outcomes in patients admitted for AHF. It is superior to serum creatinine and is clearly additive to BNP.
- © 2010 by American Heart Association, Inc.