Neutrophil Gelatinase-Associated Lipocalin in the Diagnosis of Type 1 Cardio-Renal Syndrome in the General Ward

Abstract

SummaryBackground and objectives The early identification of acute heart failure (HF) patients with type 1 cardiorenal syndrome should be the first step for developing prevention and treatment strategies for these patients. This study aimed to assess the performance of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C in the early detection of type 1 cardio-renal syndrome in patients with acute HF.Design, setting, participants, & measurements One-hundred nineteen patients admitted with acute HF were studied. NGAL and creatinine were measured in the first hospitalization morning; creatinine was also measured at least after 48 to 72 hours. Physicians were blinded to NGAL and cystatin C levels. Type 1 cardio-renal syndrome was defined as an increase in the creatinine level of at least 0.3 mg/dl or 50% of basal creatinine.Results Type 1 cardio-renal syndrome developed within 48 to 72 hours in 14 patients (11.8%). Admission NGAL levels were higher in these patients: 212 versus 83 ng/dl. At a cutoff value of 170 ng/L, NGAL determined type 1 cardio-renal syndrome with a sensitivity of 100% and a specificity of 86.7%. The area under the receiver-operating characteristic curve of NGAL was 0.93 and that of cystatin C was 0.68. ConclusionsAbove a cutoff value of 170 ng/L, NGAL predicts 48-to 72-hour development of type 1 cardiorenal syndrome with a negative predictive value of 100% and a positive predictive value of 50%. NGAL independently associates with type 1 cardio-renal syndrome and might be a useful biomarker in the early recognition of these patients.

Urinary Angiotensinogen Level Predicts AKI in Acute Decompensated Heart Failure

“…[9][10][11][12] To date, only a few small clinical studies have tested the utility of these biomarkers, mostly NGAL, in predicting acute CRS and have yielded only modest performance in general. [13][14][15][16][17][18][19] In addition, there is a particular lack of predictors for longer-term prognosis in patients with acute CRS. In each of these circumstances, the early detection of patients at high risk of developing AKI, before a detectable change in serum creatinine, would afford clinicians a critical time window to halt or reverse the ongoing renal injury.…”

Combination of Urinary Biomarkers Improves Early Detection of Acute Kidney Injury in Patients With Heart Failure

“…specificity of 86.7% when the cut-off was 170 ng/ml. 15 However, the number of patients with AKI (n=14) in the study was low. Two investigations by Tang et al explored the association between urinary NGAL and different aspects of renal dysfunction.…”

“…[11][12][13][14] Although prior research has revealed that NGAL, KIM-1, and Cys-C predict AKI in patients with ADHF separately, no study has examined whether combining markers of the 2 categories could improve diagnostic accuracy. [15][16][17][18][19] Thus, the present study investigated this hypothesis, compared the efficacy and accuracy of these markers, and explored the combined usage.…”

Urine neutrophil gelatinase-associated lipocalin levels predict acute kidney injury in acute decompensated heart failure patients

“…Only the admission NGAL measurement in acute decompensated HF was important to foresee AKI. 24 Hospitalized acute decompensated HF patients might have high admission serum NGAL levels despite normal admission creatinine values. 22 Serum and urine NGAL levels were found to be important to foresee disease progression in chronic kidney disease patients.…”