Neutrophil Gelatinase-Associated Lipocalin for Acute Kidney Injury During Acute Heart Failure Hospitalizations: The AKINESIS Study

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• 作者：Alan S. Maisel ; MD<sup>asup><sup> ; sup><sup>bsup><sup> ; sup><sup>amaisel@ucsd.edu" class="auth_mail" title="E-mail the corresponding authorsup> ; Nicholas Wettersten ; MD<sup>bsup> ; Dirk J. van Veldhuisen ; MD<sup>csup> ; Christian Mueller ; MD<sup>dsup> ; Gerasimos Filippatos ; MD<sup>esup> ; Richard Nowak ; MD<sup>fsup> ; Christopher Hogan ; MD<sup>gsup> ; Michael C. Kontos ; MD<sup>hsup> ; Chad M. Cannon ; MD<sup>isup> ; Gerhard A. Mü ; ller ; MD ; PhD<sup>jsup> ; Robert Birkhahn ; MD<sup>ksup> ; Paul Clopton ; MS<sup>asup> ; Pam Taub ; MD<sup>bsup> ; Gary M. Vilke ; MD<sup>lsup> ; Kenneth McDonald ; MD<sup>msup><sup> ; sup><sup>nsup> ; Niall Mahon ; MD<sup>nsup><sup> ; sup><sup>osup> ; Julio Nuñ ; ez ; MD<sup>psup> ; Carlo Briguori ; MD ; PhD<sup>qsup> ; Claudio Passino ; MD<sup>rsup> ; Patrick T. Murray ; MD<sup>nsup>
• 关键词：biomarkers ; cardiorenal syndrome ; diuretics ; worsening renal function
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：27 September 2016
• 年：2016
• 卷：68
• 期：13
• 页码：1420-1431
• 全文大小：621 K

文摘

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.

sSec_2">Objectives

spara0015">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.

sSec_3">Methods

spara0020">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.

sSec_4">Results

spara0025">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<sup>2sup>, a first NGAL <150 ng/ml indicated a low likelihood of adverse events.

sSec_5">Conclusions

spara0030">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]; <span id="intref0010" class="interref" data-locatorType="https" data-locatorKey="//clinicaltrials.gov/ct2/show/NCT01291836">NCT01291836span>)