Introduction: Renal injury is a significant complication in ST-segment elevation myocardial infarction (STEMI) and is associated with poor outcomes. The recently introduced term acute kidney disease (AKD) describes persistent renal dysfunction lasting 7–90 days post-acute kidney injury (AKI). Neutrophil gelatinase-associated lipocalin (NGAL), a biomarker for tubular injury, has shown promise in predicting AKI. This study aimed to evaluate NGAL's diagnostic utility for predicting AKD in STEMI patients. Methods: This prospective observational study included 312 patients admitted with STEMI. NGAL levels were measured within 2 hours of admission. AKI and AKD were defined using KDIGO criteria, and patients with chronic inflammation or end-stage renal disease were excluded. Receiver operating characteristic (ROC) analysis was performed to evaluate NGAL's predictive value for AKD and its optimal value for prediction. Results: Overall, 64 patients developed AKI (21%), with 30 (47%) progressing to AKD. Patients with AKD had higher admission NGAL levels (median 165 ng/ml) compared to those with resolved AKI (112 ng/ml) or no AKI (88 ng/ml, p150 ng/ml having 65% sensitivity and 77% specificity for correct prediction. Multivariate analysis confirmed NGAL >150 ng/ml as an independent predictor of AKD (HR 6.4, 95% CI 1.94-21.06, p<0.001). Conclusions: Elevated NGAL levels are independently associated with AKD development in STEMI patients. These findings suggest NGAL could be a valuable biomarker for early risk stratification, supporting timely interventions to mitigate persistent renal injury. Further research is warranted to confirm its clinical utility.
Frydman et al. (Fri,) studied this question.