Key result
Cardiorenal syndrome was associated with significantly increased levels of NGAL (156 vs 89.1 ng/ml, P<0.0001), BUN, and TnT compared to heart failure without renal impairment.
Why the study?
Are there differences in inflammatory, neurohormonal, and organ damage biomarkers between patients with cardiorenal syndrome and heart failure patients without renal impairment?
Observational (n=246)
Are there differences in inflammatory, neurohormonal, and organ damage biomarkers between patients with cardiorenal syndrome and heart failure patients without renal impairment?
Patients with cardiorenal syndrome exhibit significantly higher levels of biomarkers indicating renal tubular damage and neurohormonal/cardiac injury compared to heart failure patients with preserved renal function.
May inform biomarker monitoring in cardiorenal syndrome; leaves open whether NGAL elevation predicts progression or guides therapy.
BACKGROUND: Cardiorenal syndrome (CRS) is associated with increased cardiovascular morbidity and mortality; still, its biomarker pattern has been poorly evaluated so far. The aim of this study was to measure the inflammatory activation, neurohormonal status and kidney and myocardial damage in patients with CRS compared to patients with heart failure (HF) without renal impairment (RI). METHODS: We analyzed 246 patients on the basis of renal function (group 1: 120 HF patients without RI; group 2: 126 CRS patients). In each group, interleukin-6, tumor necrosis factor-α, B-type natriuretic peptide (BNP), neutrophil gelatinase-associated lipocalin (NGAL), troponin T (TnT), osteoprotegerin and blood urea nitrogen (BUN) were measured. The diagnostic power of all laboratory parameters to detect CRS was evaluated by the receiver operating characteristic (ROC) curve and logistic regression analysis. RESULTS: A significant increase in BNP [626.4 pg/ml, confidence interval (CI) 518-749 vs. 487.8 pg/ml, CI 411-578; p < 0.05], NGAL (156 ng/ml, CI 129-186 vs. 89.1 ng/ml, CI 72-109; p < 0.0001), BUN (108.9 mg/dl, CI 98-120 vs. 51 mg/dl, CI 46-55; p < 0,0001) and TnT (0.62 ng/ml, CI 0.51-0.75 vs. 0.21 ng/ml, CI 0.15-0.28; p < 0.001) was seen in CRS patients compared to HF patients without RI. ROC curve analysis showed that only NGAL, BUN, BUN/creatinine ratio and TnT can discriminate patients with CRS from patients without RI. CONCLUSIONS: In CRS patients, renal tubular damage and neurohormonal and cardiac injury activation are increased compared to patients without RI. The current biomarker pattern could be used for an early diagnosis of RI in acute and chronic HF.
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Palazzuoli et al. (2014) conducted an observational in Cardiorenal syndrome and Heart failure (n=246). Cardiorenal syndrome vs. Heart failure without renal impairment was evaluated on NGAL levels (ng/ml) (p=<0.0001). Cardiorenal syndrome was associated with significantly increased levels of NGAL (156 vs 89.1 ng/ml, P<0.0001), BUN, and TnT compared to heart failure without renal impairment.
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