Alan S Maisel1, Nicholas Wettersten2, Dirk J van Veldhuisen3, Christian Mueller4, Gerasimos Filippatos5, Richard Nowak6, Christopher Hogan7, Michael C Kontos8, Chad M Cannon9, Gerhard A Müller10, Robert Birkhahn11, Paul Clopton12, Pam Taub2, Gary M Vilke13, Kenneth McDonald14, Niall Mahon15, Julio Nuñez16, Carlo Briguori17, Claudio Passino18, Patrick T Murray19. 1. Division of Cardiovascular Medicine, Veterans Affairs Medical Center, San Diego, La Jolla, California; Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, California. Electronic address: amaisel@ucsd.edu. 2. Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, California. 3. Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. 4. Department of Cardiology, University Hospital Basel, Basel, Switzerland. 5. Department of Cardiology, Athens University Hospital Attikon, University of Athens, Athens, Greece. 6. Department of Emergency Medicine, Henry Ford Hospital System, Detroit, Michigan. 7. Division of Emergency Medicine and Acute Care Surgical Services, VCU Medical Center, Virginia Commonwealth University, Richmond, Virginia. 8. Division of Cardiology, VCU Medical Center, Virginia Commonwealth University, Richmond, Virginia. 9. Department of Emergency Medicine, University of Kansas Hospital, Kansas City, Kansas. 10. Department of Nephrology and Rheumatology, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany. 11. Department of Emergency Medicine, New York Methodist, Brooklyn, New York. 12. Division of Cardiovascular Medicine, Veterans Affairs Medical Center, San Diego, La Jolla, California. 13. Departement of Emergency Medicine, University of California, San Diego, La Jolla, California. 14. Department of Cardiology, St. Vincent's University Hospital, Dublin, Ireland; Department of Nephrology, Mater Misericordaie University Hospital, University College Dublin, Dublin, Ireland. 15. Department of Nephrology, Mater Misericordaie University Hospital, University College Dublin, Dublin, Ireland; Department of Cardiology, Mater Misericordaie University Hospital, Dublin, Ireland. 16. Department of Cardiology, Hospital Clínico Universitario Valencia, University of Valencia, Valencia, Spain. 17. Department of Cardiology, Clinica Mediterranea, Naples, Italy. 18. Department of Cardiology and Cardiovascular Medicine, Fondazione Gabriele Monasterio, Pisa, Italy. 19. Department of Nephrology, Mater Misericordaie University Hospital, University College Dublin, Dublin, Ireland.
Abstract
BACKGROUND: Worsening renal function (WRF) often occurs during acute heart failure (AHF) and can portend adverse outcomes; therefore, early identification may help mitigate risk. Neutrophil gelatinase-associated lipocalin (NGAL) is a novel renal biomarker that may predict WRF in certain disorders, but its value in AHF is unknown. OBJECTIVES: This study sought to determine whether NGAL is superior to creatinine for prediction and/or prognosis of WRF in hospitalized patients with AHF treated with intravenous diuretic agents. METHODS: This was a multicenter, prospective cohort study enrolling patients presenting with AHF requiring intravenous diuretic agents. The primary outcome was whether plasma NGAL could predict the development of WRF, defined as a sustained increase in plasma creatinine of 0.5 mg/dl or ≥50% above first value or initiation of acute renal-replacement therapy, within the first 5 days of hospitalization. The main secondary outcome was in-hospital adverse events. RESULTS: We enrolled 927 subjects (mean age, 68.5 years; 62% men). The primary outcome occurred in 72 subjects (7.8%). Peak NGAL was more predictive than the first NGAL, but neither added significant diagnostic utility over the first creatinine (areas under the curve: 0.656, 0.647, and 0.652, respectively). There were 235 adverse events in 144 subjects. The first NGAL was a better predictor than peak NGAL, but similar to the first creatinine (areas under the curve: 0.691, 0.653, and 0.686, respectively). In a post hoc analysis of subjects with an estimated glomerular filtration rate <60 ml/min/1.73 m(2), a first NGAL <150 ng/ml indicated a low likelihood of adverse events. CONCLUSIONS: Plasma NGAL was not superior to creatinine for the prediction of WRF or adverse in-hospital outcomes. The use of plasma NGAL to diagnose acute kidney injury in AHF cannot be recommended at this time. (Acute Kidney Injury Neutrophil Gelatinase-Associated Lipocalin [N-GAL] Evaluation of Symptomatic Heart Failure Study [AKINESIS]; NCT01291836).
BACKGROUND: Worsening renal function (WRF) often occurs during acute heart failure (AHF) and can portend adverse outcomes; therefore, early identification may help mitigate risk. Neutrophil gelatinase-associated lipocalin (NGAL) is a novel renal biomarker that may predict WRF in certain disorders, but its value in AHF is unknown. OBJECTIVES: This study sought to determine whether NGAL is superior to creatinine for prediction and/or prognosis of WRF in hospitalized patients with AHF treated with intravenous diuretic agents. METHODS: This was a multicenter, prospective cohort study enrolling patients presenting with AHF requiring intravenous diuretic agents. The primary outcome was whether plasma NGAL could predict the development of WRF, defined as a sustained increase in plasma creatinine of 0.5 mg/dl or ≥50% above first value or initiation of acute renal-replacement therapy, within the first 5 days of hospitalization. The main secondary outcome was in-hospital adverse events. RESULTS: We enrolled 927 subjects (mean age, 68.5 years; 62% men). The primary outcome occurred in 72 subjects (7.8%). Peak NGAL was more predictive than the first NGAL, but neither added significant diagnostic utility over the first creatinine (areas under the curve: 0.656, 0.647, and 0.652, respectively). There were 235 adverse events in 144 subjects. The first NGAL was a better predictor than peak NGAL, but similar to the first creatinine (areas under the curve: 0.691, 0.653, and 0.686, respectively). In a post hoc analysis of subjects with an estimated glomerular filtration rate <60 ml/min/1.73 m(2), a first NGAL <150 ng/ml indicated a low likelihood of adverse events. CONCLUSIONS: Plasma NGAL was not superior to creatinine for the prediction of WRF or adverse in-hospital outcomes. The use of plasma NGAL to diagnose acute kidney injury in AHF cannot be recommended at this time. (Acute Kidney InjuryNeutrophil Gelatinase-Associated Lipocalin [N-GAL] Evaluation of Symptomatic Heart Failure Study [AKINESIS]; NCT01291836).
Authors: Matthew Griffin; Veena S Rao; James Fleming; Parinita Raghavendra; Jeffrey Turner; Devin Mahoney; Nicholas Wettersten; Alan Maisel; Juan B Ivey-Miranda; Lesley Inker; Wai Hong Wilson Tang; Francis Perry Wilson; Jeffrey M Testani Journal: Am J Cardiol Date: 2019-09-06 Impact factor: 2.778
Authors: Agata Bielecka-Dabrowa; Breno Godoy; Joerg C Schefold; Michael Koziolek; Maciej Banach; Stephan von Haehling Journal: Curr Heart Fail Rep Date: 2018-08
Authors: Tariq Ahmad; Keyanna Jackson; Veena S Rao; W H Wilson Tang; Meredith A Brisco-Bacik; Horng H Chen; G Michael Felker; Adrian F Hernandez; Christopher M O'Connor; Venkata S Sabbisetti; Joseph V Bonventre; F Perry Wilson; Steven G Coca; Jeffrey M Testani Journal: Circulation Date: 2018-01-19 Impact factor: 29.690
Authors: Veli-Pekka Harjola; Wilfried Mullens; Marek Banaszewski; Johann Bauersachs; Hans-Peter Brunner-La Rocca; Ovidiu Chioncel; Sean P Collins; Wolfram Doehner; Gerasimos S Filippatos; Andreas J Flammer; Valentin Fuhrmann; Mitja Lainscak; Johan Lassus; Matthieu Legrand; Josep Masip; Christian Mueller; Zoltán Papp; John Parissis; Elke Platz; Alain Rudiger; Frank Ruschitzka; Andreas Schäfer; Petar M Seferovic; Hadi Skouri; Mehmet Birhan Yilmaz; Alexandre Mebazaa Journal: Eur J Heart Fail Date: 2017-05-30 Impact factor: 15.534