Volume 24, Issue 105, September - October, 2020

Value of plasma NGAL in the in-hospital all-cause mortality prognosis of acute heart failure or acute decompensated heart failure

Hao Thai Phan^1♦, Bao Bui Hoang², Minh Van Huynh³

¹Master in Internal Medicine, MD; Pham Ngoc Thach University of Medicine; PhD Student of Hue University of Medicine and Pharmacy, Hue University, Vietnam. Email: phanthaihao@yahoo.com
²Asssociated Professor, PhD, MD; Hue University of Medicine and Pharmacy, Hue University, Vietnam. Email: bsbao@yahoo.com
³Professor, PhD, MD; Hue University of Medicine and Pharmacy, Hue University, Vietnam. Email: dr.hvminh@gmail.com

^♦Corresponding author
Dr Phan Thai Hao, Department of Internal Medicine, Faculty of Medicine, Pham Ngoc Thach University of Medicine, 2 Duong Quang Trung, Ward 12, District 10, Ho Chi Minh city, Vietnam; Phone Number: +84 915783132; E-mail: phanthaihao@yahoo.com; haopt@pnt.edu.vn

ABSTRACT

Background: Renal dysfunction is common in patients with AHF or ADHF and is associated with significant early and late morbidity and mortality. Neutrophil gelatinase-associated lipocalin (NGAL) is an early predictor of acute kidney injury and adverse events in various diseases; however, in AHF or ADHF patients, its significance remains poorly understood. This study was aimed to evaluate the in-hospital all-cause mortality prognostic value of NGAL in AHF or ADHF patients. Methods: there were 139 patients with AHF or ADHF in the department of cardiovascular resuscitation and Interventional cardiology at Ho Chi Minh City 115 People Hospital from November 2018 to May 2019. This research was a prospective cohort study. Results: there were 21 cases (rate 15.1%) in-hospital allcause mortality or serious illness, mean age 66.12 ± 15.77, men accounted for 50.4%. The optimal cut-off of NGAL for in-hospital allcause mortality prognosis is > 399.58 ng/ml, AUC is 0.668 (95% CI 0.58-0.75, p = 0.0163), sensitivity 71.43 %, specificity 66.95 %, positive predictive value 27.8%, negative predictive value 92.9%. Patients were divided into two groups according to their plasma NGAL levels: high level (≥ 400 ng/ml) and low level (< 400 ng/ml). Kaplan-Meier analysis revealed that the high level plasma NGAL group exhibited a worse prognosis than the low level plasma NGAL group in all-cause death/serious illness (Hazard Ratio 2.56; 95%CI 1.35-4.84, P=0.0039.Independent predictors of in-hospital-all-cause-mortality/serious illness were identified using multivariable Cox proportional-hazards regression models with backward-stepwise selection method consisted of two variables: level of NGAL ≥ 400ng/ml, mean blood pressure at admission. Conclusions: Plasma NGAL ≥ 400ng/ml and mean blood pressure on admission were independent predictors of in-hospital all-cause mortality/serious illness in patients with AHF or ADHF. The survival probability in hospital of high level NGAL (≥ 400 ng/ml) groups were lower than that of low level NGAL (<400 ng/ml,), difference was statistically significant χ2 = 7.99; p = 0.0047 by Kaplan-Meier curve.

Keywords: Neutrophil Gelatinase-Associated Lipocalin (NGAL); Cardio-Renal Syndrome (CRS1) Type 1; biomarkers; in-hospital allcause mortality prognosis

Medical Science, 2020, 24(105), 2968-2978

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