Serum Neutrophil Gelatinase-Associated Lipocalin and Decreased Kidney Function as Predictor of Mortality and Major Adverse Cardiac Events during Acute Heart Failure Hospitalizations
Author : R. Maliawan, B. Nadha, R. Widiana, P. Gunadhi, Ida S., W. Wita
Upload Date : 19-04-2018
Background: Decreased renal function occurs is associated with a poor prognosis in acute heart failure patients. One of standard method for assessing the decline in kidney function is measurement of serum creatinine levels which has many limitations to assess worsening of acute kidney injury. Serum Neutrophil gelatinase-associated lipocalin (NGAL) is one of predictive biomarkers for early detection of AKI in several conditions except in acute heart failure (AHF) patients which it yield a conflicting result. The study aimed to determine the role of serum NGAL and decreased renal function, obtained from measurements of serum creatinine levels, in predicting mortality and major adverse cardiovascular (MACE) events during hospitalization in acute heart failure patients
Methods: Prospective cohort study with consecutive sampling was conducted in AHF patients who were treated at Sanglah General Hospital from July until September 2017. Serum NGAL and creatinine levels were measured at the onset of hospital admission and observed for mortality and MACE during hospitalization.
Results: Seventy-seven patients were involved in this study. We found hazard ratio (HR) serum NGAL to mortality was 7.8 (p = 0,009) and increased to 18,9 in multivariate analysis with cox proportional hazards regression test (p = 0,002). There were significant differences in survival (p = 0.002) between patients with high serum NGAL (424 hours survival rate, 95% CI 296-552) than low serum NGAL (baseline survival 680 hours; 95% CI 584-775) after log rank test. Meanwhile, the effect of serum NGAL on MACE and decreased of kidney function on mortality or MACE did not give significant result.
Conclusion: Serum NGAL is an independent predictor of in-hospital mortality in AHF. Patients with high serum NGAL level had worse survival than patients with low serum NGAL level during hospitalizations.
KEYWORDS : Acute heart failure, serum NGAL, decreased renal function, in-hospital mortality, MACE
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