Prognostic Value of Urinary Neutrophil Gelatinase-Associated Lipocalin on the First Day of Admission for Adverse Events in Patients With Acute Decompensated Heart Failure.
Prognostic Value of Urinary Neutrophil Gelatinase-Associated Lipocalin on the First Day of Admission for Adverse Events in Patients With Acute Decompensated Heart Failure.
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DOI：
10.1161/jaha.116.004582
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发表时间：
2017-05-18
影响因子：
5.4
通讯作者：
Saito Y
中科院分区：
文献类型：
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作者：
Nakada Y;Kawakami R;Matsui M;Ueda T;Nakano T;Takitsume A;Nakagawa H;Nishida T;Onoue K;Soeda T;Okayama S;Watanabe M;Kawata H;Okura H;Saito Y
尿中性粒细胞明胶酶相关脂蛋白(U-NGAL)是急性肾损伤和各种疾病不良事件的早期预测指标；然而，在急性失代偿性心力衰竭患者中，其意义尚不清楚。本研究旨在探讨入院第一天U-NGAL对急性失代偿性心力衰竭患者急性肾损伤发生及远期预后的预测价值。我们对我科2011-2014年间收治的260例急性失代偿性心力衰竭患者入院第一天24小时尿样进行U-NGAL测定。主要终点为全因死亡、心血管死亡和心力衰竭入院。根据U-NGAL中位数(32.5g/μ)分为两组。高U-NGAL组住院期间急性肾损伤发生率显著高于低U-NGAL组(P=0.0012)。Kaplan-Meier分析显示，在全因死亡(危险比2.07；95%可信区间1.38~3.12，P=0.0004)、心血管死亡(危险比2.29；95%可信区间1.28~4.24，P=0.0052)、心力衰竭入院(危险比1.77；95%可信区间1.13~2.77，P=0.0119)方面，高U-NGAL组预后较低U-NGAL组差。在估计的肾小球滤过率中加入U-NGAL显著提高了全因死亡率的预测准确性(P=0.0083)。在急性失代偿性心力衰竭患者中，入院第1天U-NGAL水平升高与临床急性肾损伤的发生有关，且与预后不良独立相关。
Urinary neutrophil gelatinase‐associated lipocalin (U‐NGAL) is an early predictor of acute kidney injury and adverse events in various diseases; however, in acute decompensated heart failure patients, its significance remains poorly understood. This study aimed to investigate the prognostic value of U‐NGAL on the first day of admission for the occurrence of acute kidney injury and long‐term outcomes in acute decompensated heart failure patients. We studied 260 acute decompensated heart failure patients admitted to our department between 2011 and 2014 by measuring U‐NGAL in 24‐hour urine samples collected on the first day of admission. Primary end points were all‐cause death, cardiovascular death, and heart failure admission. Patients were divided into 2 groups according to their median U‐NGAL levels (32.5 μg/gCr). The high‐U‐NGAL group had a significantly higher occurrence of acute kidney injury during hospitalization than the low‐U‐NGAL group (P=0.0012). Kaplan‐Meier analysis revealed that the high‐U‐NGAL group exhibited a worse prognosis than the low‐U‐NGAL group in all‐cause death (hazard ratio 2.07; 95%CI 1.38‐3.12, P=0.0004), cardiovascular death (hazard ratio 2.29; 95%CI 1.28‐4.24, P=0.0052), and heart failure admission (hazard ratio 1.77; 95%CI 1.13‐2.77, P=0.0119). The addition of U‐NGAL to the estimated glomerular filtration rate significantly improved the predictive accuracy of all‐cause mortality (P=0.0083). In acute decompensated heart failure patients, an elevated U‐NGAL level on the first day of admission was related to the development of clinical acute kidney injury and independently associated with poor prognosis.