Department of Cardiology and Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden.
Circ Heart Fail. 2014 Jan;7(1):35-42. doi: 10.1161/CIRCHEARTFAILURE.113.000242. Epub 2013 Dec 17.
In patients with heart failure, renal dysfunction is associated with a poor outcome. We aimed to assess the prognostic value of plasma neutrophil gelatinase-associated lipocalin (NGAL), a novel marker of renal tubular damage, in patients with heart failure with or without renal dysfunction, and compare it with 2 frequently used biomarkers of chronic kidney disease.
Plasma NGAL, estimated glomerular filtration rate (eGFR), and cystatin C were assessed in 562 patients with heart failure. Chronic kidney disease was defined as eGFR<60 mL/min per 1.73 m2. Outcome was all-cause mortality at 36 months. Mean age was 71±11 years, 61% were men, and 97% were in New York Heart Association functional class II/III. Mean baseline eGFR was 54±20 mL/min per 1.73 m2, mean cystatin C was 11.2 (7.7-16.2) mg/L, and median plasma NGAL was 85 (60-123) ng/mL. Higher plasma NGAL levels were independently associated with an increased risk of all-cause mortality, in patients with and without chronic kidney disease (hazard ratio [per SD increase in log NGAL]=1.45 [1.22-1.72]; P<0.001 and hazard ratio=1.51 [1.06-2.16]; P=0.023, respectively). Similarly, both in patients with high and low cystatin C (median cut-off), higher plasma NGAL levels were independently associated with an increased risk of all-cause mortality. Moreover, when NGAL was entered in the multivariable risk prediction model, eGFR (P=0.616) and cystatin C (P=0.937) were no longer associated with mortality.
Plasma NGAL predicts mortality in patients with heart failure, both in patients with and without chronic kidney disease and is a stronger predictor for mortality than the established renal function indices eGFR and cystatin C.
在心力衰竭患者中，肾功能障碍与预后不良相关。我们旨在评估血浆中性粒细胞明胶酶相关脂质运载蛋白（NGAL），一种肾小管损伤的新型标志物，在伴或不伴肾功能障碍的心力衰竭患者中的预后价值，并将其与两种常用的慢性肾脏病生物标志物进行比较。
在 562 例心力衰竭患者中评估了血浆 NGAL、估计肾小球滤过率（eGFR）和胱抑素 C。慢性肾脏病定义为 eGFR<60 mL/min/1.73 m2。36 个月时的全因死亡率为终点事件。患者平均年龄为 71±11 岁，61%为男性，97%为纽约心脏协会心功能 II/III 级。平均基线 eGFR 为 54±20 mL/min/1.73 m2，平均胱抑素 C 为 11.2（7.7-16.2）mg/L，中位血浆 NGAL 为 85（60-123）ng/mL。较高的血浆 NGAL 水平与心力衰竭患者（有或无慢性肾脏病）的全因死亡率增加独立相关（每 SD 对数 NGAL 增加的危险比[per SD increase in log NGAL]=1.45[1.22-1.72]；P<0.001 和危险比=1.51[1.06-2.16]；P=0.023）。同样，在高和低胱抑素 C（中位数切点）的患者中，较高的血浆 NGAL 水平与全因死亡率增加独立相关。此外，当 NGAL 被纳入多变量风险预测模型时，eGFR（P=0.616）和胱抑素 C（P=0.937）与死亡率不再相关。
血浆 NGAL 可预测心力衰竭患者的死亡率，无论患者是否患有慢性肾脏病，并且比已建立的肾功能指标 eGFR 和胱抑素 C 更能预测死亡率。
