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Prognostic utility of plasma neutrophil gelatinase‐associated lipocalin in patients with acute heart failure: The NGAL EvaLuation Along with B‐type NaTriuretic Peptide in acutely decompensated heart failure (GALLANT) trial
Author(s) -
Maisel Alan S.,
Mueller Christian,
Fitzgerald Robert,
Brikhan Robert,
Hiestand Brian C.,
Iqbal Navaid,
Clopton Paul,
Veldhuisen Dirk J.
Publication year - 2011
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfr087
Subject(s) - medicine , heart failure , creatinine , natriuretic peptide , hazard ratio , cardiology , renal function , acute kidney injury , lipocalin , acute decompensated heart failure , biomarker , confidence interval , biochemistry , chemistry
Aims Neutrophil gelatinase‐associated lipocalin (NGAL) is a measure of acute kidney injury. Renal dysfunction portends significant risk after discharge from acute heart failure (AHF). Thus, a sensitive marker of renal injury might also help to risk stratify HF patients. Methods and results GALLANT [NGAL EvaLuation Along with B‐type NaTriuretic Peptide (BNP) in acutely Decompensated Heart Failure] was a multicentre, prospective study to assess the utility of plasma NGAL, alone and in combination with BNP, as an early risk marker of adverse outcomes. We studied 186 patients (61% male). There were 29 events (AHF readmissions and all‐cause mortality) at 30 days (16%). Patients with events had higher levels of NGAL than those without (134 vs. 84 ng/mL, P < 0.001). The area under the receiver operating characteristic curve was higher for NGAL (0.72) than BNP (0.65), serum creatinine (0.57), or estimated glomerular filtration rate (eGFR; 0.55). In multivariable analyses, NGAL predicted events ( P = 0.001), BNP approached significance ( P = 0.052 and 0.070 without creatinine and GFR, respectively) while neither serum creatinine nor eGFR were significant. The addition of discharge NGAL over BNP alone improved classification by a net 10.3% in those with events and 19.5% in those without events, for a net reclassification improvement of 29.8% ( P = 0.010). Subjects with both BNP and NGAL elevated were at significant risk [hazard ratio (HR) = 16.85, P = 0.006], as were subjects with low BNP and high NGAL (HR = 9.95, P = 0.036). Conclusions Plasma NGAL is a measure of kidney injury that at the time of discharge is a strong prognostic indicator of 30 days outcomes in patients admitted for AHF. Clinical trial registration number: NCT 00693745