Elevated urinary neutrophil gelatinase-associated lipocalcin after acute heart failure treatment is associated with worsening renal function and adverse events

Reliable detectors of worsening renal function (WRF) in Emergency Department (ED) patients with acute heart failure (AHF) are limited. We hypothesized that initial urinary neutrophil gelatinase-associated lipocalcin (NGAL) levels, and changes in urinary NGAL levels after initial ED AHF therapy, would be associated with WRF and adverse events. Urinary NGAL upon ED presentation and 1224 h after ED treatment was measured in a cohort of ED patients with AHF. NGAL was corrected for urinary creatinine (uCr). WRF was defined as RIFLE stages 1, 2, or 3, or a creatinine increase of epsilon 0.3 mg/dL. Patients were prospectively followed for 5- and 30-day adverse cardiovascular events. The 399 patients had a median age of 63 years, 50 were Caucasian, and 62 were male. Those with WRF at 7296 h were more likely to have a higher initial NGAL value (71 vs. 32 ng NGAL/mg uCr) (P 0.005), and a higher NGAL level at 1224 h after ED therapy (107 vs. 25ng NGAL/mg uCr, P 0.001). In a multivariable model, NGAL at 1224 h remained a significant predictor of WRF (P 0.012). Of all variables available 1224 h after initial therapy, the only significant predictor of 30-day events was an elevated urinary NGAL level (P 0.02). Urinary NGAL levels determined 1224 h after ED therapy are significantly associated with both WRF at 7296 h and 30-day adverse events. This suggests that early management strategies may have an impact on subsequent WRF and outcomes. If confirmed, NGAL may have a role for guiding therapeutic decisions.