Document Detail


Elevated urinary neutrophil gelatinase-associated lipocalcin after acute heart failure treatment is associated with worsening renal function and adverse events.
MedLine Citation:
PMID:  22733980     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: Reliable detectors of worsening renal function (WRF) in Emergency Department (ED) patients with acute heart failure (AHF) are limited. We hypothesized that initial urinary neutrophil gelatinase-associated lipocalcin (NGAL) levels, and changes in urinary NGAL levels after initial ED AHF therapy, would be associated with WRF and adverse events.
METHODS AND RESULTS: Urinary NGAL upon ED presentation and 12-24 h after ED treatment was measured in a cohort of ED patients with AHF. NGAL was corrected for urinary creatinine (uCr). WRF was defined as RIFLE stages 1, 2, or 3, or a creatinine increase of ≥0.3 mg/dL. Patients were prospectively followed for 5- and 30-day adverse cardiovascular events. The 399 patients had a median age of 63 years, 50% were Caucasian, and 62% were male. Those with WRF at 72-96 h were more likely to have a higher initial NGAL value (71 vs. 32 ng NGAL/mg uCr) (P = 0.005), and a higher NGAL level at 12-24 h after ED therapy (107 vs. 25ng NGAL/mg uCr, P < 0.001). In a multivariable model, NGAL at 12-24 h remained a significant predictor of WRF (P = 0.012). Of all variables available 12-24 h after initial therapy, the only significant predictor of 30-day events was an elevated urinary NGAL level (P = 0.02).
CONCLUSIONS: Urinary NGAL levels determined 12-24 h after ED therapy are significantly associated with both WRF at 72-96 h and 30-day adverse events. This suggests that early management strategies may have an impact on subsequent WRF and outcomes. If confirmed, NGAL may have a role for guiding therapeutic decisions.
Authors:
Sean P Collins; Kimberly W Hart; Christopher J Lindsell; Gregory J Fermann; Neal L Weintraub; Karen F Miller; Susan N Roll; Matthew I Sperling; Douglas B Sawyer; Alan B Storrow
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.     Date:  2012-06-25
Journal Detail:
Title:  European journal of heart failure     Volume:  14     ISSN:  1879-0844     ISO Abbreviation:  Eur. J. Heart Fail.     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-08-22     Completed Date:  2013-01-17     Revised Date:  2014-04-15    
Medline Journal Info:
Nlm Unique ID:  100887595     Medline TA:  Eur J Heart Fail     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1020-9     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Acute-Phase Proteins / urine*
Adult
Aged
Aged, 80 and over
Cohort Studies
Disease Progression
Emergency Service, Hospital
Female
Heart Failure / physiopathology,  therapy*,  urine
Humans
Kidney Diseases / physiopathology*
Lipocalins / urine*
Male
Middle Aged
Prospective Studies
Proto-Oncogene Proteins / urine*
Risk Factors
Grant Support
ID/Acronym/Agency:
1UL1RR026314-01/RR/NCRR NIH HHS; K12 HL109019/HL/NHLBI NIH HHS; K12HL1090-01/HL/NHLBI NIH HHS; K23HL085387/HL/NHLBI NIH HHS; K23HL085387-01A2/HL/NHLBI NIH HHS; R01 HL076684/HL/NHLBI NIH HHS; R01 HL112640/HL/NHLBI NIH HHS; R01HL088459-02/HL/NHLBI NIH HHS; UL1 TR000077/TR/NCATS NIH HHS
Chemical
Reg. No./Substance:
0/Acute-Phase Proteins; 0/LCN2 protein, human; 0/Lipocalins; 0/Proto-Oncogene Proteins
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