Value of Plasma NGAL and Creatinine on First Day of Admission in the Diagnosis of Cardiorenal Syndrome Type 1

Abstract

Background. The presence of acute kidney injury in the setting of acute heart failure (AHF) or acute decompensated heart failure (ADHF) is a very common occurrence and was termed cardiorenal syndrome 1 (CRS1). Neutrophil gelatinase-associated lipocalin (NGAL) in the blood and urine is one of the earliest biomarkers of acute kidney injury due to ischemia or renal toxicity. This study was aimed to evaluate the diagnostic efficacy of plasma NGAL in the diagnosis of CRS1. Methods. There were 139 patients with AHF or ADHF in the department of Cardiovascular Resuscitation and Interventional Cardiology at Ho Chi Minh City 115 People Hospital from September 2018 to March 2019. This was a prospective cohort study. Results. There were 48 cases (rate 34.5%) with CRS1, mean age was 66.12 ± 15.77 and men accounted for 50.4%. There were no significant differences of vital signs at admission, diagnosis, and EF-based heart failure between CRS1 and non-CRS1 groups. The urea, creatinine on first day (creatinine D1) and third day (creatinine D3), NT-proBNP, and NGAL levels were higher in the CRS1 group than the non-CRS1 group, p < 0.05 . The optimal cutoff plasma NGAL for diagnosing CRS1 was >353.23 ng/ml, area under curve (AUC) 0.732 (95% CI 0.65–0.80, p < 0.001 ), sensitivity 74.47%, specificity 68.48%, positive predictive value 54.7%, and negative predictive value 84%. Multivariable logistic regression analysis eGFRCKDEPID1 remained the strongest independent predictor of CRS1. Building the optimal regression model (without eGFRCKDEPID1) by the BMA (Bayesian model average) method with two variables NGAL and Creatinine D1, we had the equation: odds ratio = ey while y = −2.39 + 0.0037 × NGAL + 0.17 × Creatinine D1. The nomogram (without eGFRCKDEPID1) was designed to predict the likelihood of CRS1 with AUC 0.79. Conclusions. The combination of plasma NGAL and creatinine D1 on the first day at admission had a high accuracy of predictive model for CRS1.

The Review of Current Knowledge on Neutrophil Gelatinase-Associated Lipocalin (NGAL)

“…The study of Dankova also proved elevated urine NGAL levels at admission to the hospital due to acute HF and predicted the following development of AKI [ 194 ]. Moreover, the report by Thai, which included 139 patients with acute heart failure, revealed that increased plasma NGAL concentrations along with elevated creatinine levels could predict the development of CRS 1 [ 195 ]. Since the rise in plasma NGAL exceeded an increase in serum creatinine, this also played a predictive role in the onset of acute kidney failure and thus allowed us to implement preventive therapeutic procedures [ 196 ].…”

Clinical Implementation and Initial Experience of Neutrophil Gelatinase-Associated Lipocalin Testing for the Diagnostic and Prognostic Assessment of Acute Kidney Injury Events in Hospitalized Patients

“…Although previous data in post-cardiac surgery AKI supported this threshold [19], more recent studies in cirrhosis-associated AKI [20, 21] and paediatric AKI [15] have shown that the optimal uNGAL cut-off to discriminate ATN from a functional AKI could be lower. On the other hand, for pNGAL, some studies reported that the optimal cut-off value could be higher in some contexts [22]. Thus, tubular damage should perhaps be seen as a continuum in which NGAL, instead of being used in a dichotomous way based on a fixed “cut-off” threshold, should be considered as an additional tool to detect the presence or absence of potential structural damage, while considering the context of potential confounders such as severe CKD, inflammation, and concomitant infection.…”

From heart failure and kidney dysfunction to cardiorenal syndrome: TMAO may be a bridge

“…MI-induced CRS in rats accelerates glomerular remodeling and the production of trace albuminuria (Dong et al, 2015). The predictive model combining plasma NGAL and creatinine D1 on the first day of admission had high accuracy in predicting CRS1 (Phan Thai et al, 2020). The combination of NGAL and NT proBNP in serum has early diagnostic value for type 1 CRS.…”