Patrick T Murray1, Nicholas Wettersten2, Dirk J van Veldhuisen3, Christian Mueller4, Gerasimos Filippatos5, Richard Nowak6, Christopher Hogan7, Michael C Kontos8, Chad M Cannon9, Gerhard A Müeller10, Robert Birkhahn11, Yu Horiuchi12, Paul Clopton12, Pam Taub2, Gary M Vilke13, Olga Barnett14, Kenneth McDonald15, Niall Mahon16, Julio NuÑez17, Carlo Briguori18, Claudio Passino19, Alan Maisel2. 1. School of Medicine, University College Dublin, Dublin, Ireland. Electronic address: patrick.murray@ucd.ie. 2. Division of Cardiovascular Medicine, University of California, La Jolla, California. 3. Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. 4. Department of Cardiology, University Hospital Basel, University of 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 Medical Center, 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. Department of Emergency Medicine, University of California, San Diego, California. 14. Division of Cardiology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine. 15. School of Medicine, University College Dublin, Dublin, Ireland; Department of Cardiology, St. Vincent's University Hospital, Dublin, Ireland. 16. School of Medicine, University College Dublin, Dublin, Ireland; Department of Cardiology, Mater Misericordaie University Hospital, Dublin, Ireland. 17. Department of Cardiology, Hospital Clínico Universitario de Valencia, INCLIVA, University of Valencia, Valencia, Spain & CIBER in Cardiovascular Diseases, Madrid, Spain. 18. Department of Cardiology, Interventional Cardiology, Mediterranea Cardiocentro, Naples, Italy. 19. Department of Cardiology and Cardiovascular Medicine, Fondazione Gabriele Monasterio, Pisa, Italy.
Abstract
BACKGROUND: Worsening renal function (WRF) during acute heart failure (AHF) occurs frequently and has been associated with adverse outcomes, though this association has been questioned. WRF is now evaluated by function and injury. We evaluated whether urine neutrophil gelatinase-associated lipocalin (uNGAL) is superior to creatinine for prediction and prognosis of WRF in patients with AHF. METHODS AND RESULTS: We performed a multicenter, international, prospective cohort of patients with AHF requiring IV diuretics. The primary outcome was whether uNGAL predicted development of WRF, defined as a sustained increase in creatinine of 0.5 mg/dL or ≥50% above first value or initiation of renal replacement therapy, within the first 5 days. The main secondary outcome was a composite of in-hospital adverse events. We enrolled 927 patients (mean 68.5 years of age, 62% men). The primary outcome occurred in 72 patients (7.8%). The first, peak and the ratio of uNGAL to urine creatinine (area under curves (AUC) ≤ 0.613) did not have diagnostic utility over the first creatinine (AUC 0.662). There were 235 adverse events in 144 patients. uNGAL did not predict (AUCs ≤ 0.647) adverse clinical events better than creatinine (AUC 0.695). CONCLUSIONS: uNGAL was not superior to creatinine for predicting WRF or adverse in-hospital outcomes and cannot be recommended for WRF in AHF.
BACKGROUND: Worsening renal function (WRF) during acute heart failure (AHF) occurs frequently and has been associated with adverse outcomes, though this association has been questioned. WRF is now evaluated by function and injury. We evaluated whether urine neutrophil gelatinase-associated lipocalin (uNGAL) is superior to creatinine for prediction and prognosis of WRF in patients with AHF. METHODS AND RESULTS: We performed a multicenter, international, prospective cohort of patients with AHF requiring IV diuretics. The primary outcome was whether uNGAL predicted development of WRF, defined as a sustained increase in creatinine of 0.5 mg/dL or ≥50% above first value or initiation of renal replacement therapy, within the first 5 days. The main secondary outcome was a composite of in-hospital adverse events. We enrolled 927 patients (mean 68.5 years of age, 62% men). The primary outcome occurred in 72 patients (7.8%). The first, peak and the ratio of uNGAL to urine creatinine (area under curves (AUC) ≤ 0.613) did not have diagnostic utility over the first creatinine (AUC 0.662). There were 235 adverse events in 144 patients. uNGAL did not predict (AUCs ≤ 0.647) adverse clinical events better than creatinine (AUC 0.695). CONCLUSIONS: uNGAL was not superior to creatinine for predicting WRF or adverse in-hospital outcomes and cannot be recommended for WRF in AHF.
Authors: Wouter C Meijers; Antoni Bayes-Genis; Alexandre Mebazaa; Johann Bauersachs; John G F Cleland; Andrew J S Coats; James L Januzzi; Alan S Maisel; Kenneth McDonald; Thomas Mueller; A Mark Richards; Petar Seferovic; Christian Mueller; Rudolf A de Boer Journal: Eur J Heart Fail Date: 2021-10-10 Impact factor: 17.349
Authors: Armando Coca; Carmen Aller; Jimmy Reinaldo Sánchez; Ana Lucía Valencia; Elena Bustamante-Munguira; Juan Bustamante-Munguira Journal: Int J Mol Sci Date: 2020-04-27 Impact factor: 5.923
Authors: Agata Zdanowicz; Szymon Urban; Barbara Ponikowska; Gracjan Iwanek; Robert Zymliński; Piotr Ponikowski; Jan Biegus Journal: J Pers Med Date: 2022-05-29