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Original Article

Prognostic Value of Plasma Neutrophil Gelatinase–Associated Lipocalin for Mortality in Patients With Heart FailureClinical Perspective

Vincent M. van Deursen, Kevin Damman, Adriaan A. Voors, Martje H. van der Wal, Tiny Jaarsma, Dirk J. van Veldhuisen, Hans L. Hillege
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https://doi.org/10.1161/CIRCHEARTFAILURE.113.000242
Circulation: Heart Failure. 2014;7:35-42
Originally published January 21, 2014
Vincent M. van Deursen
From the Department of Cardiology (V.M.v.D., K.D., A.A.V., M.H.v.d.W., D.J.v.V., H.L.H.) and Department of Epidemiology (H.L.H.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden (T.J.).
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Kevin Damman
From the Department of Cardiology (V.M.v.D., K.D., A.A.V., M.H.v.d.W., D.J.v.V., H.L.H.) and Department of Epidemiology (H.L.H.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden (T.J.).
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Adriaan A. Voors
From the Department of Cardiology (V.M.v.D., K.D., A.A.V., M.H.v.d.W., D.J.v.V., H.L.H.) and Department of Epidemiology (H.L.H.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden (T.J.).
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Martje H. van der Wal
From the Department of Cardiology (V.M.v.D., K.D., A.A.V., M.H.v.d.W., D.J.v.V., H.L.H.) and Department of Epidemiology (H.L.H.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden (T.J.).
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Tiny Jaarsma
From the Department of Cardiology (V.M.v.D., K.D., A.A.V., M.H.v.d.W., D.J.v.V., H.L.H.) and Department of Epidemiology (H.L.H.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden (T.J.).
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Dirk J. van Veldhuisen
From the Department of Cardiology (V.M.v.D., K.D., A.A.V., M.H.v.d.W., D.J.v.V., H.L.H.) and Department of Epidemiology (H.L.H.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden (T.J.).
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Hans L. Hillege
From the Department of Cardiology (V.M.v.D., K.D., A.A.V., M.H.v.d.W., D.J.v.V., H.L.H.) and Department of Epidemiology (H.L.H.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden (T.J.).
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Abstract

Background—In patients with heart failure, renal dysfunction is associated with a poor outcome. We aimed to assess the prognostic value of plasma neutrophil gelatinase–associated lipocalin (NGAL), a novel marker of renal tubular damage, in patients with heart failure with or without renal dysfunction, and compare it with 2 frequently used biomarkers of chronic kidney disease.

Methods and Results—Plasma NGAL, estimated glomerular filtration rate (eGFR), and cystatin C were assessed in 562 patients with heart failure. Chronic kidney disease was defined as eGFR<60 mL/min per 1.73 m2. Outcome was all-cause mortality at 36 months. Mean age was 71±11 years, 61% were men, and 97% were in New York Heart Association functional class II/III. Mean baseline eGFR was 54±20 mL/min per 1.73 m2, mean cystatin C was 11.2 (7.7–16.2) mg/L, and median plasma NGAL was 85 (60–123) ng/mL. Higher plasma NGAL levels were independently associated with an increased risk of all-cause mortality, in patients with and without chronic kidney disease (hazard ratio [per SD increase in log NGAL]=1.45 [1.22–1.72]; P<0.001 and hazard ratio=1.51 [1.06–2.16]; P=0.023, respectively). Similarly, both in patients with high and low cystatin C (median cut-off), higher plasma NGAL levels were independently associated with an increased risk of all-cause mortality. Moreover, when NGAL was entered in the multivariable risk prediction model, eGFR (P=0.616) and cystatin C (P=0.937) were no longer associated with mortality.

Conclusions—Plasma NGAL predicts mortality in patients with heart failure, both in patients with and without chronic kidney disease and is a stronger predictor for mortality than the established renal function indices eGFR and cystatin C.

  • heart failure
  • NGAL protein, human
  • prognosis
  • Received February 1, 2013.
  • Accepted December 9, 2013.
  • © 2013 American Heart Association, Inc.
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January 2014, Volume 7, Issue 1
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    Prognostic Value of Plasma Neutrophil Gelatinase–Associated Lipocalin for Mortality in Patients With Heart FailureClinical Perspective
    Vincent M. van Deursen, Kevin Damman, Adriaan A. Voors, Martje H. van der Wal, Tiny Jaarsma, Dirk J. van Veldhuisen and Hans L. Hillege
    Circulation: Heart Failure. 2014;7:35-42, originally published January 21, 2014
    https://doi.org/10.1161/CIRCHEARTFAILURE.113.000242

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    Prognostic Value of Plasma Neutrophil Gelatinase–Associated Lipocalin for Mortality in Patients With Heart FailureClinical Perspective
    Vincent M. van Deursen, Kevin Damman, Adriaan A. Voors, Martje H. van der Wal, Tiny Jaarsma, Dirk J. van Veldhuisen and Hans L. Hillege
    Circulation: Heart Failure. 2014;7:35-42, originally published January 21, 2014
    https://doi.org/10.1161/CIRCHEARTFAILURE.113.000242
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