Abstract 14905: Combined Assessment of Serum Neutrophil Gelatinase-Associated Lipocalin and N-Terminal Pro-B-Type Natriuretic Peptide Levels on Admission Improves the Prediction of Mortality in Patients Hospitalized to Coronary Care Units

Abstract

Background: Neutrophil gelatinase-associated lipocalin (NGAL) is best known clinically as a novel and early marker of acute kidney injury. Renal dysfunction portends significant risk in patients admitted to coronary care units (CCUs). Thus, a sensitive marker of renal injury might also help to risk stratify patients hospitalized to CCUs. We prospectively investigated the prognostic value of a combination of serum NGAL and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels on admission for mortality in patients hospitalized to CCUs. Methods: We measured serum NGAL and NT-proBNP levels on admission in 974 consecutive patients hospitalized to CCUs. Among these patients, heart failure was present in 55%, and acute coronary syndrome in 40%. Results: Serum NGAL levels significantly correlated with NT-proBNP levels (r = 0.37, p <0.0001) and estimated glomerular filtration rate (r = -0.68, p < 0.0001). During a mean follow-up period of 829 days after admission, there were 178 (18%) all-cause deaths including 145 cardiovascular deaths. Comparably, patients who died were older (median, 78 vs. 72 yrs, p < 0.0001), had higher levels of NGAL (102 vs. 55 ng/ml, p < 0.0001), NT-proBNP (4043 vs. 1250 pg/ml, p < 0.0001), D-dimer (2.6 vs. 1.1 μg/ml, p < 0.0001), and high-sensitive C-reactive protein (6.0 vs.2.0 mg/l, p < 0.0001), and displayed lower values of left ventricular ejection fraction (39 vs. 50 %, p < 0.0001) and estimated glomerular filtration rate (43 vs. 65 ml/min/1.73m 2 , p < 0.0001) than those who did not. In multivariate Cox regression analysis including 11 clinical and biochemical variables, tertiles of NGAL (p = 0.02) and NT-proBNP (p = 0.02) was independently associated with all-cause deaths. The combination of NGAL and NT-proBNP tertiles were associated with increased all-cause mortality rates ( Figure ). Conclusion: The combined assessment of NGAL and NT-proBNP levels on admission may be useful for evaluating the risk of mortality in patients admitted to CCUs.