Abstract 14538: Urinary NGAL Predicts Worsening Renal Function in Patients with Acute Decompensated Heart Failure in Both Preserved and Impaired Glomerular Filtration Rate
Introduction: Neutrophil gelatinase-associated lipocalin (NGAL) is a plasma or urinary biomarker that reflects renal tubular injury. It has shown predictive properties for acute kidney injury in different clinical scenarios including worsening renal function (WRF) in the setting of acute decompensated heart failure (ADHF). In non-heart failure populations, NGAL performs better in patients with preserved renal function.
Hypothesis: We tested the hypothesis that urinary NGAL's ability to predict WRF increases in patients with preserved renal function.
Methods: 141 patients were prospectively enrolled at 2 sites within 24 hours after hospital admission for ADHF and dichotomized according to estimated glomerular filtration (eGFR) ≥ (preserved) or < (impaired) 60 ml/min/1.73m2. Urinary NGAL, urinary and serum creatinine were measured daily for 5 days or until discharge, whichever came first. WRF was defined as a rise in creatinine of 0.3 mg/dl or more during the study period.
Results: Baseline urinary NGAL levels were not different among patients who developed WRF (28%) and those who didn't (12.6 [IQR 4.2-44.9] ng/ml vs. 8.8 [IQR 4.0-20.7] ng/ml, p=0.39 respectively). However, day 2 levels were significantly higher in WRF patients compared to those without (32.2 [IQR 9.2-80] ng/ml vs. 11.7 [IQR 5.0-30.4] ng/ml, p=0.002). WRF occurred after a median of 3 days. Baseline renal function was preserved in 71 of 141 patients (50%). When urinary NGAL on day 2 was taken as a predictor of WRF, the AUC-ROC was 0.67. Figure 1 shows the AUC-ROC for patients with preserved vs. those with impaired renal function.
Conclusions: Urinary NGAL predicts WRF during treatment of ADHF in both patients with preserved and impaired renal function. However, as in non-heart failure settings, its ability to do so seem to improve in patients with preserved renal function.
- © 2011 by American Heart Association, Inc.