Abstract
Background The presence of acute kidney injury in the setting of acute heart failure (AHF) or acute decompensated heart failure (ADHF) is a very common occurrence and was termed cardiorenal syndrome 1 (CRS1). Neutrophil gelatinase-associated lipocalin (NGAL) in the blood and urine is one of the earliest biomarkers of acute kidney injury due to ischemia or renal toxicity. This study was aimed to evaluate the diagnostic efficacy of plasma NGAL in the diagnosis of CRS1. 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 September 2018 to March 2019. This was a prospective cohort study. Results There were 48 cases (rate 34.5%) with CRS1, mean age was 66.12 ± 15.77 and men accounted for 50.4%. There were no significant differences of vital signs at admission, diagnosis, and EF-based heart failure between CRS1 and non-CRS1 groups. The urea, creatinine on first day (creatinine D1) and third day (creatinine D3), NT-proBNP, and NGAL levels were higher in the CRS1 group than the non-CRS1 group, p < 0.05. The optimal cutoff plasma NGAL for diagnosing CRS1 was >353.23 ng/ml, area under curve (AUC) 0.732 (95% CI 0.65–0.80, p < 0.001), sensitivity 74.47%, specificity 68.48%, positive predictive value 54.7%, and negative predictive value 84%. Multivariable logistic regression analysis eGFRCKDEPID1 remained the strongest independent predictor of CRS1. Building the optimal regression model (without eGFRCKDEPID1) by the BMA (Bayesian model average) method with two variables NGAL and Creatinine D1, we had the equation: odds ratio = ey while y = −2.39 + 0.0037 × NGAL + 0.17 × Creatinine D1. The nomogram (without eGFRCKDEPID1) was designed to predict the likelihood of CRS1 with AUC 0.79. Conclusions The combination of plasma NGAL and creatinine D1 on the first day at admission had a high accuracy of predictive model for CRS1.
Highlights
CRS was divided into 5 types, of which the first type is called acute cardiorenal syndrome, which is an acute cardiac dysfunction leading to injury and/or acute renal dysfunction. e prevalence of cardiorenal syndrome type 1 according to studies varies from 32% to 40% in patients hospitalized for episodes of acute decompensated heart failure (ADHF) [2]
We aimed to evaluate the diagnostic efficacy of Neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis of cardiorenal syndrome type 1 (CRS1) in acute heart failure (AHF) or ADHF patients
During November 2018 and May 2019, 172 patients were initially diagnosed with AHF or ADHF
Summary
Acute kidney injury (AKI) in the setting of acute heart failure (AHF) or acute decompensated heart failure (ADHF) is a very common occurrence and was termed cardiorenal syndrome type 1 (CRS1) [1]. CRS is a disorder of the heart and kidneys that can cause acute or chronic dysfunction of one organ to cause another. CRS was divided into 5 types, of which the first type is called acute cardiorenal syndrome, which is an acute cardiac dysfunction leading to injury and/or acute renal dysfunction. E prevalence of cardiorenal syndrome type 1 according to studies varies from 32% to 40% in patients hospitalized for episodes of ADHF [2]. It is estimated that in the United
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