Neutrophil gelatinase-associated lipocalin and cystatin C for the prediction of clinical events in patients with advanced heart failure and after ventricular assist device placement

作者:Pronschinske Katherine B; Qiu Sylvia; Wu Christina; Kato Tomoko S; Khawaja Tuba; Takayama Hiroo; Naka Yoshifumi; Templeton Danielle L; George Isaac; Farr Maryjane A; Mancini Donna M; Schulze P Christian*
来源:Journal of Heart and Lung Transplantation, 2014, 33(12): 1215-1222.
DOI:10.1016/j.healun.2014.06.007

摘要

BACKGROUND: Progressive renal dysfunction develops in patients with advanced HF. We evaluated neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C compared with established markers of renal function in patients with heart failure (HF) because they might improve prognostic assessment of patients with HF. METHODS: Serum samples were collected from 40 patients with stable HF (age: 58 +/- 8 years, body mass index [BMI]: 28.4 +/- 6.4 kg/m(2)), 40 HF patients undergoing ventricular assist device (VAD) implantation (age: 53 +/- 11 years, BMI: 26.8 +/- 5.5 kg/m(2)), 40 patients undergoing VAD removal at cardiac transplantation, and 24 controls (age: 48 +/- 7 years, BMI: 29.4 +/- 4.2 kg/m(2)). Clinical data were collected from institutional medical records. NGAL and cystatin C levels were measured by enzyme-linked immunosorbent assay and estimated glomerular filtration rate (eGFR) calculated using the Modification of Diet in Renal Disease formula. RESULTS: Patients with stable HF showed elevated NGAL and cystatin C levels compared with controls (NGAL: 114.9 +/- 48.3 ng/mL vs 72.0 +/- 36.6 ng/mL, p < 0.0001; cystatin C: 1490.4 +/- 576.1 ng/mL vs 954.7 +/- 414.2 ng/mL, p = 0.0026). Unlike cystatin C, NGAL increased in advanced HF patients requiring VAD implantation (158.7 +/- 74.8 ng/mL, p < 0.001). On VAD support, NGAL levels decreased (127.1 +/- 80.4 ng/mL, p = 0.034). NGAL was higher in patients who developed right ventricular failure (187.8 +/- 66.0 vs 130.9 +/- 67.0 ng/rnL, p = 0.03) and irreversible renal dys190.0 +/- 73.8 ng/mL vs 133.8 +/- 54.2 ng/mL, p < 0.05), whereas cystatin C, creatinine, and eGFR were not different. NGAL correlated with eGFR (r = -0.2188, p = 0.01). CONCLUSIONS: NGAL levels correlate with HF severity and hemodynamic improvement after VAD placement. Our findings suggest a role of this novel biomarker as a marker of severity and prognosis in patients with HF.

  • 出版日期2014-12