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

Abstract

AimsNeutrophil gelatinase-associated lipocalin (NGAL) is a measure of acute kidney injury. Renal dysfunction portends significant risk after discharge from acute heart failure (AHF). Thus, a sensitive marker of renal injury might also help to risk stratify HF patients.Methods and resultsGALLANT [NGAL EvaLuation Along with B-type NaTriuretic Peptide (BNP) in acutely Decompensated Heart Failure] was a multicentre, prospective study to assess the utility of plasma NGAL, alone and in combination with BNP, as an early risk marker of adverse outcomes. We studied 186 patients (61% male). There were 29 events (AHF readmissions and all-cause mortality) at 30 days (16%). Patients with events had higher levels of NGAL than those without (134 vs. 84 ng/mL, P < 0.001). The area under the receiver operating characteristic curve was higher for NGAL (0.72) than BNP (0.65), serum creatinine (0.57), or estimated glomerular filtration rate (eGFR; 0.55). In multivariable analyses, NGAL predicted events (P= 0.001), BNP approached significance (P= 0.052 and 0.070 without creatinine and GFR, respectively) while neither serum creatinine nor eGFR were significant. The addition of discharge NGAL over BNP alone improved classification by a net 10.3% in those with events and 19.5% in those without events, for a net reclassification improvement of 29.8% (P= 0.010). Subjects with both BNP and NGAL elevated were at significant risk [hazard ratio (HR) = 16.85, P= 0.006], as were subjects with low BNP and high NGAL (HR = 9.95, P= 0.036).ConclusionsPlasma NGAL is a measure of kidney injury that at the time of discharge is a strong prognostic indicator of 30 days outcomes in patients admitted for AHF.Clinical trial registration number: NCT 00693745

Acute heart failure in the young: Clinical characteristics and biomarker profiles

“…Furthermore, biomarkers associated with poor renal function (BUN, NGAL, KIM-1, galectin-3) were lower in younger patients [22][23][24][25][26]. This correlates with the finding that younger patients overall had a better renal function at admission and were less often subject to WRF during hospitalization.…”

Urinary neutrophil gelatinase-associated lipocalin (NGAL) is associated with mortality in a community-based cohort of older Swedish men

“…This is to some extent supported by other studies reporting that plasma NGAL predicts mortality in patients with pre-existing acute cerebral ischemia [18] or chronic heart failure [19,20], although u-NGAL was not evaluated in these studies. The more distinct associations in individuals with pre-existing cardiovascular diseases could also indicate that u-NGAL is an indicator of faster progression of atherosclerosis and chronic heart failure resulting in an increased mortality risk of cardiovascular causes.…”

“…Increased concentrations of s-NGAL and u-NGAL are found in patients with chronic heart failure [14,15] and with acute ischemic events [16,17] and increased plasma NGAL concentrations are also associated with a higher risk of mortality in these patient groups [18][19][20] and in the community [21]. However, the prospective association between the tubular kidney damage biomarker u-NGAL and cardiovascular death in the community is not known.…”

The emerging role of biomarkers and bio-impedance in evaluating hydration status in patients with acute heart failure

“…Although not absolutely specifi c for AKI (it is also produced and released by neutrophils) (58) , it is still an early marker of AKI. A discharge value of NGAL > 100 ng/mL, combined with BNP values or even measured alone, has been proven to be a powerful predictor of 30-day adverse outcomes (57) . Finally, a preliminary study has shown that increased plasma levels of asymmetric dimethylarginine (ADMA) are strong and independent predictor of short-and long-term mortality in AHF patients (NYHA Class III/IV) with reduced EF (59) .…”