Abstract 13460: Prognostic Value of Urinary Neutrophil Gelatinase-Associated Lipocalin for Adverse Events in Patients With Acute Decompensated Heart Failure

Abstract

Background: urinary neutrophil gelatinase-associated lipocalin (U-NGAL) has been reported as an earlier predictor of acute kidney injury (AKI) and a prognostic factor of adverse events in patients with chronic heart failure, but in acute decompensated heart failure (ADHF) patients the significance is poorly understood. Methods: We have studied consecutive 436 patients with ADHF admitted to our department from 2011 through 2014. Among these patients, 260 patients measured U-NGAL using 24-hour urine samples collected on day 1 were studied. The primary endpoints were all-cause death, cardiovascular (CV) death and HF admission. Results: We divided into two groups on the basis of the median U-NGAL levels (32.5 μg/gCr). The high U-NGAL group had significantly higher the occurrence of AKI during hospitalization than the low U-NGAL group (p=0.0012). Kaplan-Meier analysis revealed that high U-NAGL group had worse prognosis than low U-NGAL group in all-cause death (Hazard ratio (HR): 2.07; 95% confidence interval (CI): 1.38-3.12, p=0.0004), CV death (HR: 2.29; 95% CI: 1.28-4.24, p=0.0052), and HF admission (HR: 1.77; 95% CI: 1.13-2.77, p=0.0119) (Figure 1). Multivariate analysis revealed that high U-NGAL predicted all-cause death and HF admission (HR: 1.77; 95% CI: 1.17-2.72, p=0.0073; and HR: 1.69; 95% CI: 1.05-2.72, p=0.0293, respectively). In subgroup analyses, high U-NGAL predicted all-cause death in reduced LVEF (HFrEF, <50%) patients, but not in preserved LVEF (HFpEF, ≥50%) patients, with the significant interaction (p=0.0005) (Figure 2). Conclusions: In ADHF patients, elevated level of U-NGAL was related to development of clinical AKI and associated with poor prognosis.