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The association between neutrophil gelatinase-associated lipocalin and clinical outcome in chronic heart failure: Results from CORONA
Nymo, Ståle H. Ueland, Thor Askevold, Erik Tandberg Flo, T. H. Kjekshus, John Hulthe, Johannes Wikstrand, John McMurray, John J. V. van Veldhuisen, Dirk J. Gullestad, Lars
Nymo, Ståle H.
Ueland, Thor
Askevold, Erik Tandberg
Flo, T. H.
Kjekshus, John
Hulthe, Johannes
Wikstrand, John
McMurray, John J. V.
van Veldhuisen, Dirk J.
Gullestad, Lars
Abstract
Objective: To study the prognostic value of neutrophil gelatinase-associated lipocalin ( NGAL ) in chronic heart failure ( HF ) of ischaemic aetiology. Background: Neutrophil gelatinase-associated lipocalin is a marker of kidney injury as well as matrix degradation and inflammation and has previously been shown to be increased in HF. We investigated whether serum NGAL levels could provide prognostic information in chronic HF. Methods: We assessed NGAL as a predictor of primary outcomes ( cardiovascular death, nonfatal stroke and nonfatal myocardial infarction, n = 307 ) and all-cause mortality ( n = 321 ), cardiovascular mortality ( n = 259 ) and hospitalization ( n = 647 ) as well as the number of hospitalizations during follow-up for all ( n = 1934 ) and CV causes ( n = 1204 ) in 1415 patients with chronic HF ( ≥60 years, New York Heart Association class II–IV, ischaemic systolic HF ) in the CORONA population, randomly assigned to 10 mg rosuvastatin or placebo. Results: Multivariate analysis revealed that NGAL added significant information when adjusting for clinical variables, but was no longer significant when further adjusting for apolipoprotein A-1 ( ApoA-1 ), glomerular filtration rate ( GFR ), C-reactive protein ( CRP ) and N-terminal pro-brain natriuretic peptide ( NT-proBNP ). However, belonging to the highest NGAL tertile was associated with more frequent hospitalization, even after adjusting for clinical variables, GFR and ApoA-1, but not after adjusting for CRP and NT-proBNP. There was no interaction between rosuvastatin treatment and NGAL. Conclusion: Neutrophil gelatinase-associated lipocalin added no significant information to NT-proBNP and GFR in a multivariate model for primary and secondary end-points.
Keywords
cardio-renal syndrome, controlled rosuvastatin multinational trial in heart failure, heart failure, inflammation, neutrophil gelatinase-associated lipocalin
Date
2012
Type
Journal article
Journal
Journal of Internal Medicine
Book
Volume
271
Issue
5
Page Range
436-443
Article Number
ACU Department
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Controlled