Key result
Urine NGAL levels early after ST-elevation myocardial infarction were significantly associated with NT-proBNP concentrations, with an AUC of 0.67 and a 50 ng/ml cut-off showing 90% specificity for acute heart failure.
Why the study?
Is urine NGAL associated with in-hospital heart failure in STEMI patients after primary PCI?
Observational (n=61)
No
Is urine NGAL associated with in-hospital heart failure in STEMI patients after primary PCI?
Effect estimate: AUC 0.67 (95% CI 0.52-0.83)
p-value: p=0.02
Urine NGAL measured early after STEMI is independently associated with NT-proBNP levels and may serve as a highly specific marker for in-hospital heart failure.
May support early post-STEMI HF stratification; leaves open incremental value beyond NT-proBNP pending prospective validation.
BACKGROUND: Neutrophil gelatinase-associated lipocalin (NGAL) is a novel early marker of acute kidney injury for which has been shown that it can also be released from the injured myocardium. Our aim was to correlate urine NGAL with markers of in-hospital heart failure in patients with acute ST-elevation myocardial infarction (STEMI). METHODS: We prospectively included 61 consecutive STEMI patients after primary percutaneous coronary intervention and estimated admission and in-hospital urine NGAL, serum creatinine, troponin I, leucocytes, CRP, N-terminal pro brain natriuretic peptide (NT-proBNP) levels and ejection fraction by echocardiography. Urine NGAL levels were compared between patients with and without HF defined as serum NT-proBNP > 400 pmol/l and were correlated to markers of heart failure, inflammations and of kidney function. RESULTS: Urine NGAL levels and CRP was significantly higher in participants with heart failure compared to those with NT-proBNP below 400 pmol/l. Urine NGAL level of 50 ng/ml had 90 % specificity for HF, the sensitivity was low at 25 %. Comparison of participants with NGAL levels < 50 ng/ml and ≥ 50 ng/ml at admission and after 12 h revealed a significant difference in NT-proBNP levels, left ventricle ejection fraction, markers of inflammation and of kidney function. Urine NGAL level was independently associated with NT-proBNP level. CONCLUSIONS: The level of urine NGAL early after myocardial infarction is associated with NT-proBNP concentration and even NGAL levels below 137 ng/ml, the usually reported normal cut-off value, had high specificity for HF in our sample.
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Kirbiš et al. (2015) conducted an observational in Acute heart failure in ST-elevation myocardial infarction (STEMI) (n=61). Urine neutrophil gelatinase-associated lipocalin (NGAL) vs. Low urine NGAL (< 50 ng/ml) was evaluated on Acute heart failure defined as NT-proBNP ≥ 400 pmol/l (AUC 0.67, 95% CI 0.52-0.83, p=0.02). Urine NGAL levels early after ST-elevation myocardial infarction were significantly associated with NT-proBNP concentrations, with an AUC of 0.67 and a 50 ng/ml cut-off showing 90% specificity for acute heart failure.
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