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Open Access Highly Accessed Research

Plasma neutrophil gelatinase-associated lipocalin for the prediction of acute kidney injury in acute heart failure

Tobias Breidthardt124*, Thenral Socrates1, Beatrice Drexler1, Markus Noveanu13, Corinna Heinisch1, Nisha Arenja1, Theresia Klima125, Christina Züsli1, Tobias Reichlin13, Mihael Potocki13, Raphael Twerenbold1, Jürg Steiger2 and Christian Mueller13

Author Affiliations

1 Department of Internal Medicine, University Hospital Basel, Peterplatz 1, Basel, 4003, Switzerland

2 Department of Nephrology and Transplant Immunology, University Hospital Basel, Peterplatz 1, Basel, 4003, Switzerland

3 Department of Cardiology, University Hospital Basel, Peterplatz 1, Basel, 4003, Switzerland

4 Department of Renal Medicine, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK

5 Department of Nephrology, Kantonsspital, CH-5001 Aarau, Switzerland

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Critical Care 2012, 16:R2  doi:10.1186/cc10600

Published: 7 January 2012

Abstract

Introduction

The accurate prediction of acute kidney injury (AKI) in patients with acute heart failure (AHF) is an unmet clinical need. Neutrophil gelatinase-associated lipocalin (NGAL) is a novel sensitive and specific marker of AKI.

Methods

A total of 207 consecutive patients presenting to the emergency department with AHF were enrolled. Plasma NGAL was measured in a blinded fashion at presentation and serially thereafter. The potential of plasma NGAL levels to predict AKI was assessed as the primary endpoint. We defined AKI according to the AKI Network classification.

Results

Overall 60 patients (29%) experienced AKI. These patients were more likely to suffer from pre-existing chronic cardiac or kidney disease. At presentation, creatinine (median 140 (interquartile range (IQR), 91 to 203) umol/L versus 97 (76 to 132) umol/L, P < 0.01) and NGAL (114.5 (IQR, 67.1 to 201.5) ng/ml versus 74.5 (60 to 113.9) ng/ml, P < 0.01) levels were significantly higher in AKI compared to non-AKI patients. The prognostic accuracy for measurements obtained at presentation, as quantified by the area under the receiver operating characteristic curve was mediocre and comparable for the two markers (creatinine 0.69; 95%CI 0.59 to 0.79 versus NGAL 0.67; 95%CI 0.57 to 0.77). Serial measurements of NGAL did not further increase the prognostic accuracy for AKI. Creatinine, but not NGAL, remained an independent predictor of AKI (hazard ratio (HR) 1.12; 95%CI 1.00 to 1.25; P = 0.04) in multivariable regression analysis.

Conclusions

Plasma NGAL levels do not adequately predict AKI in patients with AHF.