ORIGINAL ARTICLE

Serum neutrophil gelatinase-associated lipocalin and decreased kidney function as predictor of mortality and major adverse cardiac events during acute heart failure hospitalizations

Rani Paramitha Iswari Maliawan , I Ketut Badjra Nadha, I Gde Raka Widiana, I Gusti Ngurah Putra Gunadhi, Ida Sri Iswari, I Wayan Wita

Rani Paramitha Iswari Maliawan
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Udayana/ Sanglah General Hospital, Denpasar, Bali Indonesia. Email: ranimaliawan@yahoo.com

I Ketut Badjra Nadha
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Udayana/ Sanglah General Hospital, Denpasar, Bali Indonesia

I Gde Raka Widiana
Department of Interna Medicine-Nephrology Division, Faculty of Medicine, Universitas Udayana/ Sanglah General Hospital, Denpasar, Bali Indonesia

I Gusti Ngurah Putra Gunadhi
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Udayana/ Sanglah General Hospital, Denpasar, Bali Indonesia

Ida Sri Iswari
Department of Clinical Microbiology, Faculty of Medicine, Universitas Udayana/ Sanglah General Hospital, Denpasar, Bali Indonesia

I Wayan Wita
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Udayana/ Sanglah General Hospital, Denpasar, Bali Indonesia
Online First: July 01, 2021 | Cite this Article
Maliawan, R., Nadha, I., Widiana, I., Gunadhi, I., Iswari, I., Wita, I. 2021. Serum neutrophil gelatinase-associated lipocalin and decreased kidney function as predictor of mortality and major adverse cardiac events during acute heart failure hospitalizations. Bali Medical Journal 10(2): 857-862. DOI:10.15562/bmj.v10i2.2541


Introduction: Decreased renal function is associated with a poor prognosis in acute heart failure (AHF). The current standard for assessing the decline in kidney function, creatinine, has several limitations. Serum Neutrophil gelatinase-associated lipocalin (NGAL) is one of the predictive biomarkers that was shown better at indicating an early AKI. Although several studies have examining the role of NGAL as a predictor for poor prognosis in various medical conditions, the result in AHF condition is still inconsistent. This study aimed to determine the role of serum NGAL and decreased renal function (estimated using serum creatinine) in predicting the mortality and major adverse cardiovascular (MACE) events during hospitalization in acute heart failure patients

Methods: Prospective cohort study with consecutive sampling was conducted in AHF patients who were treated at Sanglah General Hospital from July to September 2017. Serum NGAL and creatinine levels were measured at the onset of hospital admission and observed for mortality and MACE during hospitalization.

Results: Seventy-seven patients were involved in this study. We found hazard ratio (HR) serum NGAL to mortality was 7.8 (p = 0.009) and increased to 18,9 in multivariate analysis with cox proportional hazards regression model (p = 0.002). There were significant differences in survival (p = 0.002) between patients with high serum NGAL (424 hours survival rate, 95% CI 296-552) than low serum NGAL (baseline survival 680 hours; 95% CI 584-775) after log rank test. Meanwhile, the effect of serum NGAL on MACE and decreased of kidney function on mortality or MACE did not yield significant result.

Conclusion: High serum NGAL is an independent predictor of in-hospital mortality among AHF patients.

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