AIMS Kidney impairment has been associated with worse outcomes in acute heart failure (AHF), although recent studies challenge this association. Neutrophil gelatinase-associated lipocalin (NGAL) is a novel biomarker of kidney tubular injury. Its prognostic role in AHF has not been evaluated in large cohorts. The present study aimed to determine if serum NGAL (sNGAL) or urine NGAL (uNGAL) is superior to creatinine for predicting short-term outcomes in AHF. METHODS AND RESULTS The study was conducted in an international, multicentre, prospective cohort consisting of 927 patients with AHF. Admission and peak values of sNGAL, uNGAL and uNGAL/urine creatinine (uCr) ratio were compared to admission and peak serum creatinine (sCr). The composite endpoints were death, initiation of renal replacement therapy, heart failure (HF) readmission and any emergent HF-related outpatient visit within 30 and 60 days, respectively. The mean age of the cohort was 69 years and 62% were male. The median length of stay was 6 days. The composite endpoint occurred in 106 patients and 154 patients within 30 and 60 days, respectively. Serum NGAL was more predictive than uNGAL and the uNGAL/uCr ratio but was not superior to sCr [area under the curve: admission sNGAL 0.61, 95% confidence interval (CI) 0.55-0.67, and 0.59, 95% CI 0.54-0.65; peak sNGAL: 0.60, 95% CI 0.54-0.66, and 0.57, 95% CI 0.52-0.63; admission sCr: 0.60, 95% CI 0.54-0.64, and 0.59, 95% CI 0.53-0.64; peak sCr: 0.61, 95% CI 0.55-0.67, and 0.59, 95% CI 0.54-0.64, at 30 and 60 days, respectively]. NGAL was not predictive of the composite endpoint in multivariate analysis. CONCLUSIONS Serum NGAL outperformed uNGAL but neither was superior to admission or peak sCr for predicting adverse events.

中文翻译：

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血清和尿液中性粒细胞明胶酶相关脂质运载蛋白对急性心力衰竭的短期预后影响：AKINESIS 研究的结果。


目的 肾损伤与急性心力衰竭 (AHF) 的不良结局相关，尽管最近的研究对这种关联提出了质疑。中性粒细胞明胶酶相关脂质运载蛋白（NGAL）是肾小管损伤的新型生物标志物。尚未在大型队列中评估其在 AHF 中的预后作用。本研究旨在确定血清 NGAL (sNGAL) 或尿液 NGAL (uNGAL) 在预测 AHF 的短期结果方面是否优于肌酐。方法和结果 该研究是在一个由 927 名 AHF 患者组成的国际、多中心、前瞻性队列中进行的。将入院时的 sNGAL、uNGAL 和 uNGAL/尿肌酐 (uCr) 比值和峰值与入院时的血清肌酐 (sCr) 峰值进行比较。复合终点分别是死亡、开始肾脏替代治疗、心力衰竭 (HF) 再入院以及 30 天内和 60 天内任何与 HF 相关的紧急门诊就诊。该队列的平均年龄为 69 岁，其中 62% 为男性。中位住院时间为 6 天。复合终点分别发生在 106 名患者和 154 名患者体内，时间为 30 天内和 60 天内。血清 NGAL 比 uNGAL 和 uNGAL/uCr 比值更具预测性，但并不优于 sCr [曲线下面积：入院 sNGAL 0.61，95% 置信区间 (CI) 0.55-0.67，和 0.59，95% CI 0.54-0.65；峰值 sNGAL：0.60，95% CI 0.54-0.66，和 0.57，95% CI 0.52-0.63；入院 sCr：0.60，95% CI 0.54-0.64，和 0.59，95% CI 0.53-0.64；峰值 sCr：分别在 30 天和 60 天时为 0.61，95% CI 0.55-0.67，以及 0.59，95% CI 0.54-0.64]。 NGAL 不能预测多变量分析中的复合终点。结论 血清 NGAL 优于 uNGAL，但在预测不良事件方面均不优于入院或峰值 sCr。