Open Access Research article

Neutrophil Gelatinase-Associated Lipocalin (NGAL) predicts renal injury in acute decompensated cardiac failure: a prospective observational study

Stephen Macdonald123*, Glenn Arendts123, Yusuf Nagree34 and Xiao-Fang Xu5

Author Affiliations

1 Centre for Clinical Research in Emergency Medicine, Western Australian Institute for Medical Research, Level 5, MRF Building, Rear 50 Murray Street, Perth, WA6000, Australia

2 Emergency Medicine, Royal Perth Hospital, GPO Box X2213, Perth, WA6000, Australia

3 Emergency Medicine, University of Western Australia, 35 Stirling Highway, Crawley, WA6009, Australia

4 Emergency Medicine, Fremantle Hospital, PO Box 480, Fremantle, WA6959, Australia

5 Cardiology, Royal Perth Hospital, GPO Box X2213, Perth, WA 6000, Australia

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BMC Cardiovascular Disorders 2012, 12:8  doi:10.1186/1471-2261-12-8

Published: 17 February 2012

Abstract

Background

Acute Decompensated Cardiac Failure (ADCF) is frequently associated with deterioration in renal function. Neutrophil gelatinase-associated lipocalin (NGAL) is an early marker of kidney injury. We aimed to determine if NGAL measured at admission predicts in-hospital acute kidney injury (AKI) in ADCF.

Methods

A prospective observational study measured NGAL and B-natriuretic peptide (BNP) from patients with ADCF presenting to two tertiary hospitals. Patients received standard care and were followed up daily as inpatients. ADCF was defined by PRIDE score ≥ 6 and AKI by RIFLE criteria.

Results

One hundred and two patients (median age 80, IQR 69-84 years, 52% male) were enrolled. AKI developed in 22 (25%) of 90 for whom outcome data was available. Seven patients died. NGAL was significantly elevated in those who developed AKI versus those who did not (median 130 ng/ml vs 69 ng/ml, p = 0.002). NGAL was also higher in those who died (median 136 ng/ml vs 68 ng/ml, p = 0.005). AKI was significantly associated with risk of death (5/22 (23%) vs 1/68 (1.5%), p = 0.001), but not length of hospital stay. NGAL significantly correlated with admission eGFR but not BNP. For prediction of AKI, NGAL > 89 ng/ml had sensitivity of 68% and specificity of 70% with area under the receiver operator characteristic (ROC) curve of 0.71 (0.58-0.84). After adjustment for baseline renal function, the odds ratio (OR) for AKI was 3.73 (1.26-11.01) if admission NGAL > 89 ng/ml.

Conclusions

Elevated NGAL at admission is associated with in-hospital AKI and mortality in patients with ADCF. However, it has only moderate diagnostic accuracy in this setting.