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Neutrophil gelatinase-associated lipocalin does not predict acute kidney injury in heart failure

World Journal of Clinical Cases 2020年第9期8卷 1600-1607页

作者： Fiorenza Ferrari Elisa Scalzotto Pasquale Esposito Sara Samoni Flavio Mistrorigo Lilia Maria Rizo Topete Massimo De Cal Grazia Maria Virzì Valentina Corradi Rossella Torregrossa Roberto Valle Stefania Bianzina Nadia Aspromonte Matteo Floris alessandro fontanelli Alessandra Brendolan Claudio Ronco Department of Nephrology Dialysis&Transplantation International Renal Research Institute VicenzaSt.Bortolo HospitalVicenza 36100Italy Department of Internal Medicine NephrologyDialysis and Transplantation ClinicsGenoa University and IRCCS Policlinico San MartinoGenova 16132Italy Department of Cardiology Coronary Intensive Care UnitSt.Bortolo HospitalVicenza 36100Italy Department of Cardiology Coronary Intensive Care UnitChioggia HospitalVenezia 36100Italy Neonatal and Pediatric Intensive Care Unit G.Gaslini InstituteGenoa 16147Italy Department of Cardiovascular and Thoracic Sciences Catholic University of the Sacred Heart Agostino Gemelli FoundationRome 00168Italy Division of Nephrology and Dialysis Azienda Ospedaliera G.BrotzuPiazzale Ricchi n°1Cagliari 09134Italy

BACKGROUND Acute cardiorenal syndrome type 1(CRS-1)is defined by a rapid cardiac dysfunction leading to acute kidney injury(AKI).Neutrophil gelatinaseassociated lipocalin(NGAL)is expressed on the surface of human neutrophils and epithelial cells,such as renal tubule cells,and its serum(sNGAL)and urinary have been used to predict AKI in different clinical *** To characterize CRS-1 in a cohort of patients with acute heart diseases,evaluating the potentiality of sNGAL as an early marker of *** We performed a retrospective cohort,multi-centre *** January 2010 to December 2011,we recruited 202 adult patients admitted to the coronary intensive care unit(CICU)with a diagnosis of acute heart failure or acute coronary *** monitored the renal function to evaluate CRS-1 development and measured sNGAL levels within 24 h and after 72 h of CICU *** Overall,enrolled patients were hemodynamically stable with a mean arterial pressure of 92(82-107)mmHg,55/202(27.2%)of the patients developed CRS-1,but none of them required *** the NGAL delta value(AUC 0.40,95%CI:0.25-0.55)nor the NGAL peak(AUC 0.45,95%CI:0.36-0.54)or NGAL cutoff(≥140 ng/mL)values were statistically significant between the two groups(CRS-1 vs no-CRS1 patients).The area under the ROC curve for the prediction of CRS-1 was 0.40(95%CI:0.25-0.55)for the delta NGAL value and 0.45(95%CI:0.36-0.54)for the NGAL peak ***,in multivariate analysis,the risk of developing CRS-1 was correlated with age>60 years,urea nitrogen at admission and 24 h-urine output(AUC 0.83,SE=60.5%SP=93%),while sNGAL was not significantly *** In our population,sNGAL does not predict CRS-1,probably as a consequence of the mild renal injury and the low severity of heart ***,these data might suggest that patient selection should be taken into account when considering the utility of NGAL measurement as a biomarker of kidney damage.

关键词： Cardiorenal syndrome type 1 Acute kidney injury Biomarker Neutrophil gelatinase-associated lipocalin

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